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]]>The Importance of Analgesia (Pain Control) for Pet Rabbitshttps://rabbit.org/the-importance-of-analgesia-pain-control-for-pet-rabbits/
Mon, 11 Feb 2013 00:12:37 +0000http://rabbit.org/wordpress/?p=6780 Rabbits, like other companion animals, are being taken to veterinarians in increasing numbers. Over the last two decades there has been an explosion of knowledge about their medical and surgical care in the veterinary community. Rabbits are living longer and thus have the potential to experience the discomfort of illness or surgery at some time in their lives. Veterinarians have an increasing number of safe choices for managing pain in rabbits. The first step for pain management is to recognize the signs of pain in the rabbit.
Signs of Pain in Rabbits

We know that rabbits have the same neurophysiological mechanisms as humans to produce pain and therefore have the capacity to feel pain in the same manner as ourselves. Often, rabbits do not cry out or make sudden movements like humans, dogs or cats when painful areas are palpated. Signs of pain in the rabbit are often more subtle. Since rabbits are prey animals, meaning that hold a place in nature that places them in a position to be preyed upon by other animals, they have developed mechanisms to deal with that lot in life that might mask signs of illness or pain. Rabbits can become very still, pull their body up tight or lie very flat, and barely blink their eyes when they are frightened or anxious. This can give the appearance that they are “calm” to those individuals that don’t know how to read this body language. In this state rabbits may not respond to palpation of painful areas of the body or the response may be so subtle it is almost undetectable.

Rabbits are often in a state of heightened anxiety or fear when they visit a veterinary office, particularly if they are not familiar with the office or there has been a long car ride to get there. It is more likely that signs of discomfort will be detected more readily when a rabbit is in his safe, home environment where he is not trying to spend time hiding. It is vital that caregivers learn their companion rabbit’s normal behavior and pay close attention to any changes that take place that are out of the ordinary. Reporting these changes to a veterinarian will be vital in determining care for a rabbit.

The following are signs that have been associated with pain in the rabbit. Remember that not all these signs are SPECIFIC for pain and some may also occur with nonpainful conditions. However, all these signs are abnormal and should be cause for further investigation.

Abnormally “hunched” appearance when sitting

Alert but reluctant to move

Moves slowly or with effort

Eyes partially closed when there is activity around that should create interest (in a new or active environment a rabbit’s eyes should normally be open and round in shape)

Limping

Unusual or sudden aggression, particularly when handled if this was not the case before

Loss or decrease in appetite or water consumption

Tooth grinding

Hiding (when it is not usual behavior)/facing the corner or pressing the head in a corner

Shows no interest in the surroundings (loss of curiosity)

Crying or “grunting” when moving/defecating/urinating or being handled/examined

Coat is unkempt due to loss of interest in grooming

Taking a long time to eat

Dropping food out of the mouth

If moderate or severe pain is not managed in a rabbit, then over time there are a number of serious and possibly life threatening side effects that may develop which include:

Gastric (stomach) ulcers

Cardiomyopathy (heart muscle disease)

Alterations in the gastrointestinal (GI) flora which may lead to a shut down of the GI tract or other disease
• Drop in body temperature

Renal ischemia (lack of blood supply causing damage to kidney)

Importance of Analgesia in Rabbits

Domestic rabbits maintain the physiology and behavior of a prey species and they experience pain in the same manner as other companion animals. Even though a rabbit may be handled frequently, he will respond to pain and stress in the same manner as his wild ancestors and as seen above if moderate to severe pain is not managed it can have serious consequences. Therefore it is ESSENTIAL that pain relief be used appropriately in rabbits in order in improve the quality of their lives and the treatment success. I believe that rabbits should be given the benefit of the doubt and if the condition that is diagnosed or the surgery that is performed would be painful in humans or other companion mammals, then it should be assumed that it is painful in rabbits and pain management should be used.

Common situations in rabbits where pain management is used include: surgical intervention, gastrointestinal disease, dental disease, trauma, and arthritis.

Analgesic Choices

There are a great many excellent and safe choices for analgesia in the rabbit. I have listed the most common ones below.

Safe, quiet, comfortable environment
I cannot say enough about providing a safe, quiet, comfortable environment for a rabbit to help minimize stress and the intensity of pain. Excessive noise, handling and lack of safety can intensify the level of pain any animal or human might be feeling. Having a hiding or safe protected area is important any time but particularly so when a bunny is not feeling well. It should be an area that is easily uncovered by the caregiver (such as an upside down cardboard box with a hole cut in the side which can be gently lifted) so the rabbit isn’t disturbed greatly when he needs to be seen.

Keep noise to a minimum including barking dogs and running, noisy children. Don’t have a rabbit’s living area right next to the stereo or the TV. Minimize handling, especially picking up the rabbit and carrying him around while he is ill. Keeping litter boxes clean and having appropriate amounts of hay and fresh foods available is also important. Please see more about proper rabbit care.

Drugs (oral, injectable or transdermal)Opioids – these drugs are related to morphine and there are several safe and effective candidates in this category. They are most often used for bone pain and as part of a pre and post surgical pain management protocol. These drugs are most often given by injection, but some can be given orally or as a transdermal patch on the skin.

Non-Steroidal Anti-inflammatory Drugs (NSAIDs) – these drugs are the most commonly used analgesics and include meloxicam, carprofen and others. NSAIDs are the most common analgesics used for chronic pain. They have both analgesic and anti-inflammatory properties so they are often used with mild to moderate pain. NSAIDs appear to be well tolerated in rabbits for long periods of time. They can be given orally or by injection.

Other pain medications – there is currently investigation into many other pain medication drugs such as tramadol. It is likely that more and more drugs will become available as veterinarians report their experiences using these products and more scientific research is performed.

Drug combinations – many times it is necessary to use more then one type of analgesic to treat a painful condition. In some cases, rabbits become resistant to the effects of a drug that has been used for a while and it may be necessary to change to a different analgesic.

Local Anesthetics
Local anesthetics can be administered in the form of topical creams or drops or by injection into the skin. The most common uses of local anesthetics in the rabbit include minor skin procedures (skin biopsies, small tumor removals, IV catheter placement), ophthalmic procedures (tear duct flushing and thorough eye exam) and nasoesophageal tube placement (the drops are put in the nose so the small tube can be placed in the awake patient without discomfort). Local anesthetics are not meant to be used for long term analgesia and their duration of action is fairly short.

Epidural Anesthesia
Epidural anesthesia is performed by injecting an anesthetic agent into the spinal fluid of a sedated rabbit which produces numbness from the injection site backwards down the spine. This is what is commonly used currently with women experiencing childbirth. Epidural anesthesia is currently most useful to control postoperative pain after an abdominal surgical procedure, particularly GI surgery. This would be a short-term anesthesia and would have to be administered and monitored in a veterinary clinic.

Acupuncture
Acupuncture as a form of analgesia goes back thousands of years. It is well established in humans and in the veterinary community that this form of therapy can be very effective in controlling pain under certain conditions. It is a form of therapy that is worth investigating particularly for chronic or persistent pain.

Chiropractic/Acupressure/Massage
All of these modalities can have a place in relieving pain. Gentle side-to-side rocking massage of the belly can be useful particularly in cases of gastrointestinal disorders where gas is produced. Chiropractic adjustments may help joint or spinal pain and acupressure used appropriately may relieve mild to moderate pain in a variety of areas.

Conclusion

Rabbits definitely benefit from the use of analgesia in painful conditions. The humane choice is to use analgesia in the painful rabbit. It is important for caregivers to work with their veterinarian to provide important observations on how their companion rabbit is responding to analgesic treatments and to also provide the most comfortable environment for their bunny’s recovery. Rabbits deserve the same humane pain management care that we would expect for ourselves!

When we ask for details, we often learn that not only did the bunny stop eating, but she had been producing extremely small or even no fecal droppings, or showed symptoms of “runny stool.” True diarrhea (unformed, liquid fecal matter) is uncommon in rabbits. The runny stool sometimes misidentified as “diarrhea” in rabbits is more often composed of unformed, almost-liquid cecotropes.

Rabbits produce two types of pellets: fecal pellets (left in the litterbox) and cecotropes (soft, pungent, normally shaped like a cluster of grapes and reingested by the rabbit to obtain essential nutrients). Liquid or mushy cecotropes can result from an imbalance of the normal bacterial and fungal flora of the cecum (the bunny’s intestinal “fermentation vat”). The floral imbalance can be caused by a number of factors, such as the wrong antibiotic (oral penicillins and lincosamine antibiotics can be very dangerous to rabbits for this reason!) or a diet too rich in digestible carbohydrates and too low in crude fiber. Often, however, it is caused by a slowing of the normal peristaltic muscular contractions which push food and liquids through the intestines. The slowdown or cessation of peristalsis of the intestine is known as gastrointestinal (GI) stasis or ileus.

What Causes GI Stasis?

A rabbit’s intestine can become static for a variety of reasons, including (1) stress, (2) dehydration, (3) pain from another underlying disorder or illness (such as gas, dental problems, infections, or urinary tract disorders) (4) an intestinal blockage or, (5) insufficient dietary crude fiber. Left untreated, the slowdown or complete cessation of normal intestinal movement (peristalsis) can result in a painful death, in a relatively short period of time. If your rabbit stops eating or producing feces for 12 hours or more, you should consider the condition an EMERGENCY. GET YOUR BUNNY TO A RABBIT-SAVVY VETERINARIAN IMMEDIATELY.

An intestinal slowdown can cause ingested hair and food to lodge anywhere along the GI tract, creating a potential blockage. Also, because the cecum is not emptying quickly enough, harmful bacteria such as Clostridium species (related to the ones that cause botulism and tetanus) can proliferate, their numbers overwhelming those of the normal, beneficial bacteria and fungi in the cecum. Once this overgrowth occurs, gas emitted by the bacteria can cause extreme pain. Some Clostridium species also produce potentially deadly toxins. It is the liver’s job to detoxify these poisons, at a high cost to that all-important organ. Damage to the liver can be a serious–even life-threatening–side effect of GI stasis.

How Can GI Stasis be detected?

Symptoms of GI stasis include very small (or no) fecal pellets, sometimes clinging to the bunny’s bottom. In some cases, very small fecal pellets will be encased in clear or yellowish mucus. This potentially serious problem (enteritis, an inflammation of the intestinal lining) should be treated as an emergency.

With GI stasis, the normal, quiet gurgling of the healthy intestine may be replaced either by very loud, violent gurgles (gas moving around painfully!) or silence. The bunny may become lethargic, have no appetite and may hunch in a ball, loudly crunching his teeth in pain.

GI Stasis and the “Hairball” Myth

Sometimes, a rabbit suffering from GI stasis is diagnosed as having a “hairball.” In reality, an apparent hairball usually is a result of GI stasis–not the cause. A vet who has not palpated many rabbit abdomens may be unfamiliar with the normal, sometimes “doughy” feel of the healthy rabbit stomach. A “doughy” stomach is usually cause for concern only when accompanied by an empty lower GI and symptoms of abdominal discomfort.

Like those of most herbivores, the stomach and intestines of a healthy rabbit are never empty. A rabbit may eat relatively normal amounts of food, almost up to the time the GI tract shuts down. Because of this, the stomach may contain a large bolus of food when stasis occurs. Unlike the typical cat hairball, which usually consists entirely of hair, a mass misidentified as a “hairball” in a rabbit is usually composed mostly of food held together by hair and mucus. Such a bolus, even if it is dehydrated and unable to pass out of the stomach when initially found, usually can be broken down slowly with plenty of oral fluids and even enzyme supplements, if the vet deems them necessary. However, if the mass is there as a result of chronic GI stasis, simply treating the mass without addressing the GI stasis will be unproductive in the long term.

If you suspect that your bunny is experiencing GI stasis, you must take him/her to your rabbit-experienced veterinarian without delay. Tell the vet your suspicions. S/he will probably listen for normal intestinal sounds and palpate the bunny’s abdomen. The vet also may wish to take radiographs (x-rays) to see whether the various parts of the digestive tract contain normal ingested matter, feces or foreign objects–or are empty and gassy. The appearance of the digestive tract will help the vet determine whether there is an obstruction and, if so, where it is located.

If a true intestinal obstruction (almost always accompanied by severe bloating and acute pain) is present, the use of intestinal motility drugs (described later) could make the situation worse by pushing the blockage into a narrow area where it completely obstructs the intestine. However, if the mass is not causing an acute, complete blockage, medical alternatives to surgery should be considered first. A gastrotomy–surgical opening of the stomach–may be performed to remove a gastric obstruction, but rabbits who undergo this procedure have an abysmally low survival rate. Those who survive the surgery itself often succumb a few days later to peritonitis or other complications, even when under the care of the most practiced, skillful rabbit surgeon. Surgery on the rabbit GI tract should be considered only as a last resort.

Can GI Stasis Be Successfully Treated?

If your vet has determined that there is no intestinal obstruction, there are several treatments s/he may wish to use to help your bunny in distress. As always, do not perform any of these procedures or try to administer any of these medications without the supervision of a veterinarian experienced with rabbit disorders and treatments.

I. Mechanical Treatments

A. Abdominal massage

One of the single most effective ways to stimulate a lazy gut into action is with gentle massage. Place the bunny on a secure countertop on a towel (or in your lap, if the bunny feels secure there), making sure he can’t jump down and hurt himself. With your hands and fingertips, gently massage the abdomen. Knead as deeply as the bunny will allow, but back off immediately if he expresses pain. We have found that gently lifting the rabbit’s hindquarters a few inches (with the bunny’s head safely tucked into the massager’s elbow, and the spine firmly supported) helps gas to pass more easily, and seems to be comforting to the bunny. Once s/he gets over the initial surprise of being held this way, a rabbit will often allow his/her legs to droop in comfort and relief as the massage helps gas pockets move towards the exit.

A rabbit’s internal organs are very delicate; care must be taken to avoid bruising them and making the situation worse. After a bit of manual massage, try an electric vibrating massager. This seems to be as effective as manual massage, and it’s worthwhile to invest in some type of massager with a large, flat surface that can be held against the bunny’s tummy for relatively long periods. Press the massager firmly against the abdomen, start on low and work your way higher. The bunny may be a bit taken aback at first, but almost every bunny on whom we’ve tried massage has settled down and enjoyed the soothing vibrations. In addition to stimulating the muscles, the massage seems to help break up gas bubbles and ease colic. Massage as long and as often as the bunny will allow and enjoy.

B. Simethicone

Simethicone (in liquid, pediatric suspension or tablets) is essential for the relief of gas pain which usually accompanies ileus. For relief of acute gas pain, 1-2 cc (20mg/ml suspension) can be given as often as every hour for three doses, then 1 cc every three to eight hours. This substance has no known drug interactions, is not absorbed through the intestinal lining and acts only on a mechanical principle: it changes the surface tension of the frothy gas bubbles in the gut, joining them into larger, easier-to-pass bubbles. Simethicone is practically inert, and is safe to give, even as a precaution, as long as it is not given long term. (Note: liquid suspensions of simethicone are relatively expensive. Less expensive versions, such as 125mg gel capsules are equally effective. A bunny can safely receive the contents of half a capsule at the rate described above.) A flatulent bunny is a happy bunny!

C. Monitoring Body Temperature

Of utmost importance is careful monitoring of body temperature via (plastic, unbreakable) rectal thermometer. Normal rabbit body temperature ranges from about 101o – 103o F. A higher temperature may indicate either stress or an infection, the latter requiring immediate veterinary attention. A temperature lower than 101oF is of even greater concern than a mildly elevated temperature. Abnormally low body temperature (hypothermia) may indicate shock or septicemia, a bacterial infection that has entered the bloodstream. A rabbit with a temperature lower than 100o F should be considered an extreme emergency. Pack the rabbit with warm water bottles wrapped in towels and get him to your rabbit-savvy veterinarian immediately. Medications often will not be effective when given to a rabbit suffering from hypothermia, so the first step in saving your bunny’s life is to get his body temperature back into normal range. Warm water bottles and warmed subcutaneous fluids can be used to achieve this end, but it can take an hour or more if the bunny is severely hypothermic.

D. Enema

It may be helpful to administer an enema of warm, clean water mixed with a very small bit of unscented, laxative grade mineral oil. The addition of epsom salts to the enema liquid (at a rate of about 1 tablespoon per 30-40 cc’s of water) may help draw fluid from surrounding tissues into the intestine, helping hydrate impacted matter. If you use epsom salts, however, you must be certain that the bunny is generally well hydrated with subcutaneous Lactated Ringer Solution so the reservoir of fluids in the bunny’s body will not be depleted.

Before you attempt to perform an enema on your rabbit, please ask your veterinarian to instruct you in this process during a regular office visit. Don’t wait for an emergency to learn how to do this. If you cannot reach your vet when your bunny is in stasis, you will be out of luck!

We administer the enema with a pediatric rubber ear bulb/syringe. A 5 lb rabbit can safely be given 10-15 cc’s of liquid enema. Mix the water and oil well. Place the bunny on her back, well supported so she doesn’t kick. Gently insert the lubricated tip of the syringe into the anus, no deeper than 1/2 – 3/4 inch. (Note: if you’re not sure which orifice is the right one, the anus is the one that winks back at you when touched.) Be gentle. NEVER FORCE ANYTHING! Slowly empty the bulb and let the bunny remain on her back for at least 30 seconds, to allow the liquid to travel up the tract a bit. When you allow the bunny to flip back into normal position, gently lift her hindquarters a couple of inches (firmly supporting the spine!) so that the liquid travels up the GI tract. You may need to gently hold the anus closed to avoid a fountain.

WE DO NOT RECOMMEND THAT A CATHETER BE USED TO DELIVER AN ENEMA. The rabbit’s lower GI tract is extremely delicate and fragile, and it is distressingly easy to perforate the rectum or small intestine, with disatrous results. The ear syringe works well, and is far safer than inserting a catheter deep into the lower GI tract.

An enema delivers liquid to the source. It can help hydrate hardened, dehydrated fecal matter in the lower GI, even when subcutaneously administered fluids don’t seem to help. The very presence of the warm liquid also seems to stimulate the muscles of the lower GI tract.

E. Petroleum-based laxatives: use with caution

Laxative-grade mineral oil or commercial products such as Laxatone or Petromalt do not affect intestinal motility. Some veterinarians prescribe them in the hope that they might help to slide dry, impacted matter through the intestine more easily.

Note, however, that if the intestinal contents are severely dehydrated and brick-hard (yes, we have seen this!), a coating of vaseline-like substance over them will merely impede their re-hydration and make it more difficult for the mass to break up and begin passing normally. For this reason, it is probably wise to concentrate on re-hydrating the intestinal contents before using petroleum-based laxatives, if they are to be used at all.

Note also that whereas malt-flavored remedies in a tube are often preferred by the bunny, some vets believe that their higher viscosity may actually contribute to holding a mass of impacted food together, especially if the intestinal contents are dehydrated. Unscented, laxative grade mineral oil is less viscous, and may be more effective. Always administer such substances with care so that the bunny does not aspirate (inhale) any. Petroleum-based laxatives should not be given daily or long term, as they can impede the absorption of important, fat-soluble vitamins.

II. Non-prescription Supportive Measures

A. Oral fluids

Fluids (normal fluid intake for a healthy mammal is approximately 90 – 100cc per kg–or about an ounce per pound–of body weight per day) are essential for hydrating intestinal contents that may have formed a hard mass and be nearly impossible to pass. Water is best, but unsweetened Pedialyte, an electrolyte drink designed for human infants (and available in the infant section of the grocery store), may also be used. Avoid any fluids containing large amounts of sugar (even Gatorade), as these can exacerbate the overgrowth of harmful bacteria in the cecum.

B. Force feeding

Anorexia can cause gastric ulcers and hepatic lipidosis (fatty liver disease) relatively rapidly in rabbits. Even 12 hours without eating is cause for concern. As long as your vet has determined that there is no actual blockage, and that there is enough slow movement of the GI to keep the stomach from becoming overly full, keep the bunny eating! An excellent, ready-to-mix emergency food for compromised rabbits is Critical Care.

However, if you do not have ready access to Critical Care, one quick and easy recipe is to soak about 2 – 3 tablespoons of pellets in about 1/2 cup of warm water or chamomile tea until they are soft and fluffy. The pellets will fluff more quickly in slightly warmed solution, but overheating may destroy some of the nutrient content of the pellets. Mix the pellet fluff with additional water or tea, vegetable baby food or even with canned pumpkin until it forms a somewhat liquid paste with the consistency of pudding. Allow to cool before using a large-bore feeding syringe (available at most pharmacies) to deliver the goods.

Insert the tip of the syringe into the space behind the incisors and squeeze gently sideways to avoid squirting food down the trachea (windpipe). Give only 1-2 cc at a time, allowing the bunny time to chew and swallow. Aspiration of food can be life threatening, so do this with great care!

C. Unlimited grass hay

Provide plenty of fresh grass hay, such as timothy. Even if the rabbit won’t eat timothy, oat, brome or other grass hays, it is probably best to avoid offering alfalfa hay. Alfalfa is too high in protein and calcium to be a healthy part of the rabbit diet. It also is more likely to cause bloat, and more likely to harbor the parasitic fungi that produce potentially deadly mycotoxins than grass hays. For these reasons, we never feed alfalfa hay, even to healthy rabbits.

D. Fresh, wet, leafy herbs

The fiber and moisture in fresh vegetables also will help stimulate the intestine. Kale is a good choice. If the rabbit refuses to eat, try fragrant, fresh herbs such as mint, basil, dill, cilantro, tarragon, sage, fennel, parsley and others. Sometimes it helps to nip off the ends of the stems and wave the fresh, juicy stems under the bunny’s nose or even gently insert the stem into the corner of the bunny’s mouth. You can even lightly pat the herbs against the bunny’s face until she gets annoyed with you and grabs the offending sprig. Sometimes all it takes is a little taste to get the bunny nibbling. Try a variety until one of them gets the bunny to eat. You never know which herb will stimulate the appetite, so it’s best to have a variety on hand.

E. Lactobacillus acidophilus

This is not normally a member of the rabbit’s intestinal ecosystem, but we have noticed that a good dose of dried Lactobacillus powder (available at health food stores in powder or capsules) seems to help the rabbit survive the crisis until the intestine starts moving again. No one knows why (and some would disagree), but it seems to help. It certainly does not hurt. Use non-dairy powder–NOT yogurt. The milk sugars and carbohydrates in yogurt may promote growth of harmful bacteria.

Probiotic pastes such as Benebac are available at feed stores, and also might be helpful. Products designed for horses are generally safe and possibly effective for rabbits.

F. Cecotropes

Some veterinarians believe that cecotropes from a healthy rabbit, although difficult to obtain, can be used to re-establish normal cecal flora in a compromised rabbit. However, other veterinarians and experienced rabbit caretakers are of the opinion that administering cecotropes to a sick rabbit may do more harm than good for two reasons: (1) force feeding cecotropes is very stressful to a sick rabbit, since no one likes being force-fed someone else’s poop and (2) even a known, healthy donor rabbit could harbor microorganisms in the cecotropes that could become pathogenic in an already compromised rabbit.

Also, because the normal cecotrope is coated with mucus that protects the bacteria while they travelthrough the stomach, mashing the cecotropes into a pellet mush might well render them useless. Given time and the proper supportive care, your rabbit will be able to re-establish a healthy cecal flora on his own, without the stress of being force fed foreign cecotropes.

However, if you and your vet absolutely insist on trying this, you can obtain cecotropes from a donor rabbit by diapering the donor, or briefly placing an E-collar on him/her during the late afternoon when cecotrophy usually occurs. Don’t use the E-collar if the donor rabbit seems very stressed or upset by it. (You don’t need two rabbits suffering from GI stasis!)

III. Prescription/Veterinary Treatments

A. Motility Drugs

An intestinal motility agent, such as cisapride (Propulsid) or metoclopramide (Reglan) will help get a static intestine moving again. Both of the aforementioned drugs are safe and effective for rabbits. Cisapride, a more recently developed drug, has fewer potential nervous system side effects with long term use than Reglan. We have used it long term (for several weeks at a time) without apparent adverse side effects. However, as with any drug, your veterinarian should be aware of any potential drug interactions between cisapride/metaclopramide and any other medications your rabbit may be taking. For example, narcotic painkillers should never be given with Reglan due to the potential for dangerous interaction between the two.

It may take as long as two weeks on metaclopramide and/or cisapride before the intestine is fully motile again, and patience and careful nursing for the duration are essential. In severe cases of GI stasis, both drugs can be used simultaneously. Because they work on different areas of the digestive tract, they may have a synergistic effect.

Conventional wisdom holds that if there is a possibility of an intestinal obstruction, these drugs should not be used. However, more and more rabbit-savvy veterinarians are noting that unless there is a problem with the pyloric valve or an acute and true blockage of the stomach, motility drugs generally do not make the problem worse. So far, there is no consensus on this aspect of the problem, and it will be up to your veterinarian (and you, as your bunny’s health advocate) to determine the course that seems right for your bunny. Once again, it is imperative that you not take matters into your own hands. Have an experienced rabbit vet diagnose the problem and prescribe proper treatment!

B. Subcutaneous Fluid Therapy

Note that examining a rabbit’s skin turgor (via “tenting” the skin) will often not give an accurate indication of the animal’s hydration status. A more useful diagnostic procedure for rabbits is palpation of the intestinal tract, which will feel very “doughy” throughout if the rabbit is dehydrated. Because rabbits absorb large amounts of water into their tissues from the intestine to drive other bodily functions, a rabbit whose skin feels well-hydrated may still have an intestine packed with a dehydrated mass. Keeping the tissues well-hydrated via appropriate administration of subcutaneous Lactated Ringers Solution (LRS) under your vet’s supervision will not only keep the bunny well hydrated, but will also ensure that the electrolytes are balanced and make the bunny feel better in general.

A dehydrated rabbit will feel tired and ill, and may not have as much will to live as one who is well-hydrated. Rabbits in GI stasis tend to be unwilling to eat or drink, so it may be a good idea to administer subcutaneous fluids as a precaution, unless the rabbit has known kidney or heart malfunctions, or other problems that your vet will be able to determine that would contradict administration of subQ fluids.

As with the enema described previously, you should be able to do this procedure at home. But do not wait for an emergency to learn how to do it. Have your vet teach you how to administer fluids during a regular office visit. It could save your bunny’s life.

C. Cholestyramine (Questran)

This is a granular resin with a high affinity for negatively charged, hydrophobic compounds, such as those produced by Clostridium spiroformes as toxins. Cholestyramine is used in human medicine to reduce serum cholesterol, and so is readily available at most pharmacies. If the rabbit has mucus in the stool, there is a good chance that Clostridium bacteria are proliferating and producing dangerous exotoxins. Questran will absorb these and be passed out harmlessly in the feces. Questran should be suspended in a generous amount of liquid (1/2 teaspoon of powder in at least 20 cc of water) and administered orally: because of its hydrophilic properties, it can dehydrate intestinal contents if given with insufficient water. Questran does not affect the action of the intestine; it is not absorbed by the body. Rather, it works directly upon the contents of the gut. We believe this substance has helped save the lives of many rabbits suffering from a severely inflamed intestine simply by sequestering toxins and buying time while gut motility medications and other treatments get the intestine moving again. It is safe and effective, used as directed.

D. Enzymatic digestive aids

These can be helpful in loosening and softening an impacted mass of food and hair (which, we remind you, is usually a symptom, not the cause of the problem!). Proteolytic (protein-dissolving) enzymes may be of either plant or animal origin. Papain (found in papaya) and bromelain (found in pineapple) may help to break down mucus binding an obstruction, thus allowing it to slowly break up and pass. However, there is no evidence to suggest that these enzymes break down keratin, which is the main protein component of hair. Both papain and bromelain are available in powdered form at most health food stores, and should be reconstituted in water or Pedialyte shortly before use to ensure maximum potency. Papaya tablets are little more than a sugary treat: they contain very little active enzyme.

A note on pineapple: Canned pineapple juice is useless, as it has been cooked, and its enzymes denatured and inactivated. Even fresh pineapple juice is not as desirable as powdered bromelain, since it is high in sugar, which is just about the last thing you want to add to a compromised rabbit’s intestine! Only fresh or frozen pineapple will provide active enzymes (bromelain). However, neither bromelain nor papain (papaya enzyme) dissolves keratin, the main protein component of hair. The sugars in pineapple juice may actually promote overgrowth of Clostridium spp.

If a hair/food mass proves particularly stubborn, even after rehydration efforts and plant enzymes have been tried, your vet may wish to try a more powerful, animal-derived enzyme product such as Viokase, which contains pancreatic enzymes to break down proteins, amylases to break down indigestible carbohydrates and lipases to break down fats. Although these enzymes may be better than bromelain or papain at breaking down an obstruction composed of ingested matter, they should be used with great caution, as they can burn the esophagus and cause temporary (two or three days) discomfort in an already sick bunny. If Viokase is to be used, it may help to administer just enough pediatric simethicone or laxative grade mineral oil to coat the esophagus for a moment just before the enzyme solution is given.

E. Appetite stimulants

B-complex vitamins, administered orally or injected, or Periactin (cyproheptadine) can be used to stimulate appetite. The former not only help stimulate appetite, but might also help supply what the bunny is missing by not producing or eating his cecotropes. Periactin is available in 4 mg tablets or a 1 mg/ml liquid suspension. An average-sized (4 – 6 lbs.) rabbit can be given 1mg by mouth, twice per day. It is vital to keep the bunny eating, even if you must force-feed. Anorexia can rapidly result in gastric ulcers and serious liver degeneration.

F. Antibiotics: Use with caution, if at all

Some vets routinely prescribe antibiotics for a rabbit suffering from GI stasis, either to combat the overgrowth of Clostridiumspp. (metronidozole [Flagyl] is often used for this purpose) or to prevent secondary bacterial infection in the compromised rabbit (other rabbit-safe antibiotics such as the fluoroquinolones or sulfas might be used for this purpose.) While such cautionary measures may be taken, the practitioner should recall that unnecessary use of antibiotics is a prime reason that so many resistant strains of bacteria are evolving even as we speak. Unless the rabbit shows signs of bacterial infection (which can sometimes be the reason the intestine shut down in the first place), we urge a conservative approach: don’t use antibiotics unless they are absolutely necessary.

IV. Pain Relief: The Key to Keeping the Bunny Fighting to Live

The importance of analgesia to a rabbit’s recovery cannot be overstated. A rabbit suffering from GI stasis will sometimes just seem to give up and die, possibly because of the sometimes extreme abdominal pain. Although officially approved only for use in horses, flunixin meglumine (Banamine) is an excellent NSAID (non-steroidal anti-inflammatory drug) for use in rabbits. Although this drug can produce gastric ulcers in some species, substantial anecdotal evidence (involving many hundreds of rabbits over a period of many years) suggests that Banamine is tolerated well by rabbits, even when administered daily for several weeks. We have observed no adverse side effects from Banamine in our rabbits, some of whom have had to receive it daily for a week or longer.

Meloxicam (metacam) and Rimadyl (carprofen) are other NSAIDs which have been used with good results in rabbits.

Torbugesic, an opioid analgesic, provides good pain relief at relatively low doses. Although some practitioners fear that an opioid might contribue to GI slowdown, pain can certainly do the same. We have used opiods repeatedly in cases like this, with good results. We also have had success at relieving colic pain and inflammation of the intestinal lining with sulfasalazine, a combination sulfa antibiotic and NSAID compound. Sulfasalazine works topically to reduce intestinal inflammation.

Barium also may be useful as an intestinal “tonic” to relieve pain and help stimulate peristalsis, but its action is slow as compared to that of the aforementioned analgesics. As always, your veterinarian is the one best able to decide which type of pain relief is appropriate for your rabbit, given the specific conditions of his/her illness.

It is essential that the caretaker faced with a rabbit in GI stasis be patient, allowing the treatments and medications to work. Rabbits are easily stressed, and excessive handling should be avoided. It may take several days before any fecal pellets are seen, and it may take two weeks or more of motility therapy before the intestine is moving normally again. We know of one case in which a rabbit produced no fecal pellets for 14 days, but finally did respond to gentle, consistent administration of the above treatment regimen. Patience and persistence are key.

Do not make more trips to the veterinarian’s office with the rabbit than absolutely necessary (the stress of travel can slow recovery), but DO contact your veterinarian frequently to report on progress and any changes. Whenever possible, administer medications at home, where the rabbit feels safe and secure.

While you are treating your sick bunny, NEVER separate him/her from his/her bonded partner(s). The stress of separation itself can make the problem worse. We have known bunnies who seemed at death’s door to recover when they were provided with the love and constant attention of their bonded mate. If your bunny does not have a mate, it is even more important that you, his best friend, show him a great deal of calm attention and affection during his ordeal. Rabbits seem to understand when they are being fussed over, and it may help them recover more quickly to know that they are not being abandoned in their misery. But do this within reason. Many a rabbit can sense a caregiver’s fear for his safety, and this in itself can cause stress. Visit and love your bunny, but also give him time to himself to recover.

Every bunny parent should have a stethoscope (not necessarily an expensive one) to monitor intestinal sounds. The gradual return of gentle gurgling is a very good sign: once this begins, the rabbit is on the road to recovery, even if fecal pellets don’t begin pouring out the chute. Administration of intestinal motility agents, gentle massage and supportive care as recounted above should be continued, and gradually tapered as fecal pellets slowly begin to come through the system.

Do not be alarmed if the first batch of fecal pellets is small, hard and misshapen, and even accompanied by some mucus. This is to be expected. Also do not be surprised if the rabbit produces a small bunch of pellets, nothing for a day, and then a bit more. The intestine sometimes seems to regain its function in fits and starts, rather than all at once. Consistent, gentle nursing and reduction of stress are essential at this time.

PLEASE RESIST THE TEMPTATION TO FORCE ADDITIONAL, AGGRESSIVE TREATMENT ONCE THE RABBIT BEGINS TO RECOVER. RECOVERY FROM GI STASIS IS SOMETIMES MADDENINGLY GRADUAL. [We know of one instance in which a rabbit was starting to produce fecal pellets and showing signs of recovery, but the veterinarian overseeing the case insisted on anesthetizing the rabbit to perform oral gavage, enemas with an extension tube and vigorous abdominal massage. Despite advice to the contrary, this veterinarian believed that the mass in the stomach could not possibly pass without such treatment. Tragically, the rabbit died. Necropsy revealed a ruptured liver. We cannot help but wonder whether excessive handling and the unnecessarily aggressive treatments contributed to, or even caused this rabbit’s demise.]

VI. MOST IMPORTANT OF ALL: Backtracking to the Cause

Remember: Ileus is not an illness in and of itself. It is a SYMPTOM of an underlying disorder that has caused the bunny enough stress or pain to cause the GI tract to slow down or stop. Hence, ileus may be your first clue that something else is wrong that needs proper diagnosis and treatment.

Once your bunny is recovering from the immediate GI stasis threat, it’s time to look for the ultimate cause of the problem.

Does your rabbit get insufficient fiber in her diet?

Are you giving her too many starchy treats?

Does she have an underlying infection or illness that’s causing enough pain/stress to shut down her intestine?

Does she have overgrown molars or an abscessed tooth? (NOTE: It is wise to check this possibility at the first sign of any change in your rabbit’s eating habits. If your bunny has overgrown molars, this alone can cause an unwillingness to eat certain items, or even result in complete anorexia.)

Have there been major changes in the household that are causing psychological stress to the bunny (loss of the bunny’s bonded partner, a new pet in the house, visitors, construction, etc.)?

Any of the above could trigger an ileus event, and must be diagnosed and corrected if your bunny is not to suffer a chronic recurrence of the ileus problem. If your rabbit does not seem fully normal, even after the GI tract is moving well again, it’s time to ask your vet to do some blood work, a deep oral exam (to check for molar problems), radiographs (don’t forget the head!), a complete check of the urinary tract, and any diagnostics your rabbit-experienced veterinarian deems necessary to get to the root of the problem.

DO NOT wait for an emergency to find a veterinarian who is experienced and good with rabbits. Unfortunately, many emergency clinics will not even see rabbits, let alone know how to properly care for one in acute distress. A veterinarian who treats a rabbit as if s/he were a dog or cat might do more harm than good. Plan now and avoid heartache later! Find a good rabbit vet in your area via the House Rabbit Society Veterinarian Listings.

VII. Prevention: The Best Medicine

The best cure for GI stasis is prevention. Be sure your rabbit companion gets plenty of dietary fiber from fresh grass hay. Feed high fiber (22% or higher crude fiber) pellets. Be sure your rabbit is drinking sufficient water to keep ingested food hydrated and moving smoothly. It helps to offer at least 4 cups of fresh, wet leafy greens per 5 lbs. of rabbit daily. And don’t forget that regular exercise not only keeps the skeletal muscles strong: it also keeps the smooth muscles of the intestines well-toned and active.

Regular visits (including a molar check!) to your rabbit-experienced veterinarian will ensure that your bunny pal doesn’t develop health problems that go undetected. Once such a problem becomes serious, it may manifest itself as GI stasis.

So here’s to healthy peristalsis! May your home be blessed with great, big, healthy piles of gorgeous bunny poops. All in the litterbox, of course.

by Dana M. Krempels, Ph.D.

Department of Biology
University of Miami
Coral Gables, FL 33124

copyright July 1997 – Dana Krempels

Revised: June 2005

This article is dedicated to Alex, who died because no one attending him recognized the symptoms of ileus before it was too late. Alex, I wish I had known then what I know now. But your life and untimely passing inspired this article, which I hope will save the lives of other rabbits.

The author gratefully acknowledges the assistance of Mary Cotter, Ed.D., and Susan Kelleher, D.V.M., for their input and feedback.

I also thank George Flentke, Ph.D. (University of Wisconsin Pharmacology Dept.) for information on the pharmaceuticals named in this article. I thank Mary Cotter, Ed.D., for her contribution to treatment protocols and for her editorial expertise. I also thank Kevin Johnson for his support and editorial expertise.

The treatments and protocols outlined in this article were developed after discussions with many veterinarians familiar with the condition of ileus in rabbits. In particular, I wish to thank (in alphabetical order) Thomas Goldsmith, D.V.M., Jeff Jenkins, D.V.M, Susan Kelleher, D.V.M., and Maya Menchaca, D.V.M. Also, several experienced, knowledgeable rabbit rescuers have contributed hints and tips for home treatments. Of these contributors, Mary Cotter Ed.D. has been an invaluable resource and constant inspiration.

Slim and sleek. This is veterinarian and author Dr. Susan Brown’s description of what a healthy rabbit looks like, although lack of exercise, poor diet, and overfeeding can drastically change that appearance.

Increased weight interferes with normal activities and puts a rabbit at higher risk for many health problems. Dr. Brown, who has been an exotic animal veterinarian for over thirty years, with a special interest in rabbits, notes some of them: cardiovascular, joint, gastrointestinal, urogenital, and liver diseases. Should there be any reason for surgery, an obese rabbit is at greater risk as well. In addition, an obese rabbit who is unable to hop around loses out on so many things, including the fun of exploring and following that inquisitive nose.

Signs of Obesity

In addition to the visible change in a rabbit’s shape and agility, a caregiver may notice:

Soft cecotropes present around the anus and in the cage or litter box area

Difficulty grooming, resulting in a dull or stained coat

Interference with eating or drinking (large dewlap)

Urine scald; inability to posture correctly

Folds of skin around anal area, where cecotropes, feces, and urine collect

Note that the signs listed above are not exclusive to obesity and may be indicative of some other health problem.

Diagnosis, Treatment, and Prognosis for Recovery

A qualified veterinarian can determine whether additional health issues (e.g., arthritis, pododermatitis) are a concern. Determining the rabbit’s ideal weight and the length of time necessary to achieve that goal will help to establish a course of action that the caregiver can follow.

Inappropriate diet is the primary cause of weight gain; thus, diet becomes the focus for treatment. As noted in the “Home Care” section below, the best diet is comprised primarily of grass hay, fed daily in unlimited quantities. Safe weight loss occurs when a rabbit is put on the appropriate diet and is eating large quantities of hay. For additional information, reference “Disorders of the Cecum” as well as diet-related articles and FAQ sheets on this website.

Home Care of an Overweight Rabbit

If an obese rabbit is put on an inappropriate diet and loses weight too rapidly, the rabbit can become ill very quickly and be at risk for hepatic lipidosis. In this condition, fat cells replace liver cells, resulting in a severely damaged liver. If a rabbit becomes anorexic (loses his appetite) for any reason, the condition should be considered an emergency and treated before hepatic lipidosis becomes a threat.

Dr. Tomáš Chlebeček, who regularly treats rabbits at his clinic, stresses the importance of an appropriate diet:

To achieve and sustain safe weight loss, it’s important that a rabbit consume a healthful diet. Most important is free access to grass hay. When a variety of grass hays are available, I recommend offering a mix, though caregivers should be aware that alfalfa is often in with orchard grass. I seldom recommend alfalfa for companion rabbits and never for overweight rabbits.

Straw is never a substitute for grass hay, regardless of how obese a rabbit may be. Though fibrous, it is devoid of good nutritional value: it’s too low in both calories and protein, and it lacks valuable trace minerals. Feeding an obese rabbit a diet of straw is potentially dangerous and can lead to fatal hepatic lipidosis. Even if the diet were supplemented with some pellets and leafy greens, the rabbit would likely suffer muscle problems and weakness. The rabbit would suffer in other ways too – he would not be a happy, content bunny.

When a rabbit is obese, food pellets are usually part of the reason and their reduction must be accomplished slowly, especially if the rabbit is not eating the proper amount of grass hay on a daily basis. If the pellets are alfalfa-based, I recommend a gradual change to a timothy-grass-based food. Mixing the two foods allows for gradual introduction of the new pellet.

Free-feeding of pellets must be discontinued for the health of the rabbit. I suggest that caregivers divide a measured amount of pellets into two feedings (e.g., morning, evening), which often has the added benefit of encouraging the rabbit to browse hay between feedings. If a pellet mix contains morsels such as dried legumes or corn, grains of any kind, or high-carbohydrate foods, those items should be discarded.

Fatty foods (e.g., seeds) and high-starch/high-sugar foods can lead to serious problems and should not be fed, even as treats.

Dr. Brown comments further:

Although leafy green vegetables can be a part of a healthy rabbit’s diet, feeding them in excess can cause a rabbit to lose weight too quickly and be unable to maintain proper weight over time. This is because fresh foods are less calorie-dense than hay due to the high water content. In addition, feeding too many greens will fill up a rabbit, making him less likely to eat hay, the most important part of the diet. It is preferred to discontinue leafy greens during a serious weight-loss program.

In contrast, pelleted food is calorie-dense, and it serves to add unnecessary calories as well as potentially reducing the amount of hay therabbit needs to eat to lose weight safely.

The most rapid way to accomplish healthy weight loss is to feed a diet of quality grass hay only. There are, however, two very important considerations with this: the rabbit must be freely grazing hay throughout the day, and the hay must be of good quality. If either of those conditions is not met, then a rabbit must be fed pellets to ensure proper nutrition and prevention of hepatic lipidosis; this has already been addressed.

Quality hay is not always available locally or throughout the year, and quality can vary for various reasons, such as climate, soil, and the way the hay is handled and stored. One very general guideline is to feed the same hay as is fed to horses, not the pasture grass that is fed to ruminants (e.g., cattle, sheep). When there is difficulty locating a good source for quality hay, the local or regional rabbit rescue group can often provide assistance.

If your rabbit refuses grass hay, don’t become discouraged. One way to entice a hesitant rabbit is by offering the hay as part of a homemade cardboard toy. For example, stuff an empty plastic-wrap tube with hay. Eventually most bunnies will begin eating hay in the proper amounts. This can sometimes be more easily accomplished when the overweight rabbit is in the company of other rabbits. It may be necessary, however, to separate the overweight rabbit from his bunny pal(s) during feeding time, especially when the other rabbit is fed pellets. Entice the overweight rabbit to a different area by offering just a few little pieces of greens, keeping Dr. Brown’s comments above in mind. Even after weight loss is accomplished and the rabbit is on a maintenance diet, the bunnies may have to be separated during feeding time to ensure that the once-overweight rabbit does not overeat. Separating the rabbits also allows each to eat at his or her own pace.

In addition, after weight loss the rabbit’s maintenance diet can also include more leafy green vegetables. However, measuring the amount of vitamin-rich greens remains important, and they should be restricted if they make the rabbit less likely to eat hay. It is also recommended that caregivers base the pellet amount on the individual needs of a rabbit (e.g., health, age, weight, activity level); the amount fed one rabbit may not be appropriate for another. Supervising the kind and amount of treats is another consideration. Perhaps include some non-food “treats” in order to keep the emphasis on grass hay, the single most important part of the diet. Reference the various diet-related articles on this website for further discussion.

Monitoring the rabbit’s environment – for example, protecting against high temperatures that can quickly lead to heat stroke – will help prevent other health problems. Giving an overweight rabbit plenty of opportunity for exercise and playtime is important. If the rabbit has a buddy (of any species), social time will become more enjoyable when the overweight rabbit is able to move more easily.

When a rabbit is obese, gentle touch can help comfort and also reduce stress. In the article “Deepening the Bond: How to Connect with Your Rabbit through Massage,” licensed massage therapist Chandra Beal advises that “laying on of hands or light fur strokes would be appropriate for showing affection and reducing stress while the bunny is dieting.” Tellington TTouch® is another form of bodywork that can benefit your rabbit. Providing extra attention will help turn the rabbit’s focus from food to more enjoyable forms of interaction.

UNDERWEIGHT RABBITS

There are many reasons a rabbit may be underweight. Some rabbits suffer from malnourishment early in their life; parasites can result in weight loss. But the primary reasons are the ones discussed by Dr. Susan Brown:

The most common reason for weight loss is decreased appetite and, thus, a reduced intake of calories. This is generally due to disease, including dental, gastrointestinal, cardiovascular, musculoskeletal (arthritis of joints or the spine), metabolic (liver, pancreas, or kidney), and cancer. Most of these involve either pain that will make it difficult for the rabbit to eat or a build up of toxins in the body that affect the brain and other organs, making the rabbit feel either nauseated or not hungry. Infectious disease, particularly upper respiratory, may make it difficult for a rabbit to smell food and thus will reduce appetite.

In addition, a diet that is primarily composed of fresh vegetable greens instead of grass hay can be very dangerous because the greens have fewer calories, due to high water content. This will lead to unhealthy weight loss. Rabbits should always be fed a diet that is primarily grass hay, offered in unlimited amounts. Inadequate availability of fresh water may reduce food intake as well.

There are other considerations. If the rabbit becomes anxious because of activity near the feeding area, such as a barking dog, active children, or other loud noises, the rabbit may not want to eat. When there is more than one rabbit, a dominant one may guard the food and prevent other rabbits from having access to it. This is one reason that I recommend that grass hay be available in several widely spaced locations.

Being alert to potential weight loss can help prevent serious problems. If a rabbit refuses food for an extended period of time, such as twenty-four hours, caregivers should be concerned because rabbits cannot fast, not even when ill or injured. A sudden cessation of eating or a decreased amount of feces signals a problem as well. Continued inappetence can quickly result in a life-threatening condition. Without intervention, gastrointestinal hypomotility (slowdown of transit times in the digestive system) can lead to GI stasis (shutdown). Hepatic lipidosis also becomes a threat.

Diagnosis, Treatment, and Prognosis for Recovery

Dr. Jason Hutcheson, whose practice is devoted solely to rabbits and other exotic animals, indicates various steps in making a diagnosis:

If the cause cannot be determined by a physical exam, we proceed to a full work-up, which includes a complete blood count, serum chemistries, urinalysis, and radiographs. These diagnostics often pinpoint diseases such as renal failure (kidney disease), dental disease, liver disease, certain cancers, or chronic infection.

Sometimes lifestyle, not disease, is the causative factor in weight loss. Poor diet can result in weight loss as well as weight gain, and so I always discuss the importance of the appropriate diet. Factors such as age, agility, and exercise options are also part of my discussion with the rabbit’s caregiver.

In addition, it’s helpful to hear about the rabbit’s life, including house location and other animal companions or children the rabbit lives with. For example, it may be that the rabbit’s area is too warm, another pet appears threatening, the rabbit is in a high-traffic area or, conversely, isolated away from the family, or perhaps children inadvertently mishandle the rabbit. Such stressors may inhibit a rabbit from eating and drinking as he should.

Dr. Tomáš Chlebeček discusses the impact of pain on weight loss:

If the rabbit is exhibiting pain, the cause must be determined and addressed or the rabbit will rapidly decline. Blood work can often help pinpoint the problem. A common cause of pain, especially in rabbits who don’t eat enough hay, are molar points (spurs). These razor-sharp lateral projections are caused by abnormal molar wear. They cut the tongue and cheek, creating a painful condition that prevents the rabbit from eating. A less obvious source of pain can be caused by elongated tooth roots, with or without abscesses, also caused by lack of eating hay; this can only be diagnosed with a lateral-lateral skull X-ray. Of course, other dental disorders cause hyporexia [diminished appetite], such as maloccluded incisors.

Rabbits do not have much of an energy reserve. It is critical to syringe-feed anorexic rabbits until they can eat on their own. Because it’s specially formulated for ailing rabbits, I recommend Critical Care™ but a mashed pellet slurry can also be fed.

There are some additional considerations, as noted by Dr. Brown:

Since pain is a common cause of weight loss, pain management is often one of the treatments. In cases such as arthritis of the joints or spine, the treatment may be for the lifetime of the rabbit. In cases such as infectious or metabolic disease, the appetite may return after the condition is addressed. There are many factors to consider when treating a rabbit for weight loss. It’s important to realize that treatment is not simply a matter of increasing caloric intake.

Note: Rabbits’ teeth have an apex instead of a true “root,” but the word “root” is used in this article.

Home Care of an Underweight Rabbit

If a rabbit is ill or injured, a home-care plan will be prescribed by the veterinarian. Eliminating stress to the extent possible is important for every bunny and especially for the underweight rabbit. A proper diet and other considerations are also important, as Dr. Chlebečekexplains:

It’s not necessarily a good idea to increase the amount of processed pellets in an underweight rabbit’s diet. Determining the cause for underweight guides my recommendations for diet.

In many cases, an underweight rabbit will benefit from increased consumption of fiber-laden foods, especially grass hay and, to a much lesser extent, leafy greens. (However, too many greens can lead to weight loss instead of weight gain.) A high-fiber diet reduces dental and other health problems. In addition to any underlying health issues, it’s important to look at all the factors that might be contributing to the rabbit’s eating behavior. For example, if an underweight bunny eats slowly, it may be necessary to give him uninterrupted feeding time away from the company of other animals and children.

Sometimes an ill or elderly rabbit may require special dietary attention, perhaps needing a measured amount of quality pellets or homemade ground-pellet mush, but the rabbit should also be encouraged to eat grass hay.

Although it’s logical to assume that a less-active rabbit will gain weight, the opposite is sometimes the case. Weight loss can result from a reduction in muscle mass, often due to inadequate exercise caused by decreased mobility, lethargy, pain when moving, or because the rabbit is caged too much of the time. Extended time outside of the cage is important. Placing hay bins and litter boxes in several locations may also stimulate more activity. Rabbits will often have greater ease of movement if a rug or other heavy material is placed on smooth floors (e.g., wood or tile). When a rabbit has a buddy, one of them often leads the other on excursions, facilitating increased exercise.

When there are two or more rabbits, caregivers should also be mindful of social issues. Observing actions surrounding the food – such as one rabbit guarding the food area or thwarting the others’ attempts to get at food or water – will enable the caregiver to make necessary changes for the benefit of all the rabbits. For example, grass hay can be made available in several locations, spaced apart.

ADDITIONAL CONSIDERATIONS

Several articles posted on this website were referred to in this two-part article or may otherwise be of interest:

Caregivers may want to consider supplementing their rabbit’s care with alternative therapies, some of which are addressed in separate articles posted on this website. There are times when combining the expertise of both standard and alternative treatments offers the best supportive care. When researching complementary treatments, be aware of training and qualification requirements and give careful consideration to the health, nature, and needs of your rabbit. Be clear and realistic about your expectations and goals for treatment, which should prioritize your rabbit’s comfort and quality of life.

I wish to extend my sincere gratitude to Drs. Susan Brown, Tomáš Chlebeček, and Jason Hutcheson for sharing their expertise in this article and additionally to Dr. Brown for her overall review of the article. Warm thanks to Cheryl Abbott, Sandi Ackerman, Heidi Anderson, Dr. Stephanie Crispin, Gary McConville, and Karen Witzke for their suggestions. – Marie Mead

Marie Mead has been involved in various capacities with animal rescue, advocacy, and education for over twenty years. She has made a home with special-needs rabbits and other animals, all of them rescues. Author (with collaborator Nancy LaRoche) of Rabbits: Gentle Hearts, Valiant Spirits – Inspirational Stories of Rescue, Triumph, and Joy, Marie has also written rabbit-related stories and articles for other publications. Additional writings have covered topics such as aging and the environment.

Susan Brown, DVM, is the founder and former owner of Midwest Bird and Exotic Animal Hospital (originally in Westchester, Illinois) and the current owner of Rosehaven Exotic Animal Veterinary Services and The Behavior Connection (North Aurora, Illinois). She is coauthor of Self-Assessment Color Review of Small Mammals and author of numerous lay and professional writings on rabbit medicine and care; she has also lectured extensively in the United States and Europe. She is involved in exotic animal care at rescue organizations and shelters. Utilizing the principles of behavior and training, she is teaching ways for people to live in harmony with their companion animals.

Tomáš Chlebeček, DVM, is a former aerospace engineer who became a veterinarian as a result of his association with the Colorado House Rabbit Society. He received his degree from Colorado State University in 1999 and practiced at the Makai Animal Clinic in Kailua, Hawaii, before moving to the Czech Republic.

Jason Hutcheson, DVM, is the owner of For Pet’s Sake, the Avian and Exotic Animal Hospital of Atlanta. After graduating in 1998, he joined the veterinary staff at For Pet’s Sake and eventually purchased the practice from Dr. Mimi Shepherd in 2006. He treats rabbits every day for individuals and for the Georgia House Rabbit Society and has written articles for their newsletter.

BIBLIOGRAPHY

My sincere thanks to the veterinarians named in this article for sharing their expertise during personal interviews and in subsequent feedback. In addition to House Rabbit Handbook: How to Live with an Urban Rabbit, the following list of publications, although by no means comprehensive, may assist those who desire additional research.

Alternative therapies can be very useful in treating rabbits for many acute and chronic conditions. The modalities work best when utilized in combination with traditional veterinary therapies. Although amazing results can be achieved, it is important that both the veterinarian and the animal’s caregiver discuss expectations for the therapies used. The most important goals would be to make the rabbit patient more comfortable, less anxious, and to have an improved quality of life.

Careful consideration of training and qualifications should be made when choosing veterinarians who use alternative therapies in their practice. As with other alternative modalities, some complementary treatments discussed in this article also require specific knowledge about rabbits; for example, an acupuncturist should be familiar with rabbit physiology.

This article discusses the use of microcurrent electrical therapy, cranial electrotherapy stimulation, cold laser therapy, and acupuncture, and the way they are used in rabbits for pain management, musculoskelatal issues like arthritis, and wound healing.

We use cranioelectrical stimulation (CES) for all of our surgery patients to decrease pain and anxiety. As a result, we are often able to decrease the amount of anesthetic needed for each procedure and patients wake up faster.

Microcurrent electrical therapy (MET) and cranial electrotherapy stimulation (CES), both generally known as Alpha-Stim®, are FDA-authorized prescription medical devices for treatment of pain, depression, and insomnia in humans. Both MET and CES have also been found to be useful in treating animals for pain and for stimulating wound healing.

MET promotes healing, sterilizes wounds, and modulates pain by initiating and sustaining biochemical and electrical reactions that work with the body’s electromagnetic fields. CES works to normalize the overall electrical firing of the brain’s hypothalamus to bring it back into homeostasis (internal equilibrium, or balance). This is referred to as the alpha state, which is similar to that produced by meditation.

At the primary author’s veterinary practice, MET and CES are used alone and in combination on a regular basis for all species: as an adjunct therapy for surgical pain, to help extensive wounds heal faster, for stress and anxiety-related disorders (e.g., over-grooming, separation anxiety), as well as for lameness, arthritis, and other pain-associated problems. The electrical current stimulates healing, helps eliminate infection, decreases the amount of anesthetic needed for surgical procedures, and helps to eliminate or diminish anxiety and pain.

The primary author has used MET and CES on many rabbits with great success, for arthritis, large traumatic wounds, chronic gastrointestinal hypomotility (slowdown), and head tilt. The therapy is also very beneficial for rabbits with anxiety and stress-related issues. Even in cases where the primary problem may not be correctable, head tilt for example, the therapy may help to restore musculoskeletal function that has been affected and eases the stress associated with the condition.

Cranioelectrical stimulation (CES) and microcurrent electrical therapy (MET) can be used in combination to aid in wound healing as in this rabbit with a leg injury.

Alpha-Stim® is a non-invasive and drug-free therapy, and since the electrical stimulus is in the low microamperes, even animals as sensitive as rabbits do not feel pain or discomfort from the therapy. Within five minutes they adjust to the application and within ten minutes they become more relaxed.

In the primary author’s experience, MET and CES are effective adjuncts to the standard care provided to patients. When used in conjunction with other medical therapies, the two modalities have certainly helped rabbit patients become more comfortable and heal faster.

Cold Laser Therapy

Cold laser therapy is utilized in human physical therapy and rehabilitation and is also a useful tool for treating rabbits. The word “laser” is an acronym for “light amplification by stimulated emission of radiation.” The definition of laser includes mention of a device with an output that is in the visible region of the electromagnetic spectrum, which includes the entire range of radiation. Cold laser therapy incorporates a low-level radiation output, produced as a concise, targeted transmission that allows for minimal reflection and scattering while maximizing energy absorption at a specific depth. The energy is not the same as from the surgery laser, which cuts and burns; thus the name “cold” laser.

Cold laser therapy can be used for postoperative pain control (along with analgesics, of course) and incisional healing. Incisions tend to heal faster and the hair also grows back faster.

By using what is known as photobiostimulation, the energy (in the form of photons) from the laser is transmitted to the cells of injured tissue. By increasing cellular activity [photons stimulate mitochondria to accelerate the production of ATP (adenosine triphosphate)], the energy promotes healing. Local blood circulation is also stimulated, providing necessary nutrients to and bolstering the immune system in the affected area. Other physiological effects of laser therapy include the stimulation of fibroblast and collagen production (necessary for generating new connective tissue for wound healing), production of endorphins (natural pain killers), acceleration of the inflammatory process needed for healing, and increased angiogenesis (the formation of new blood vessels) and lymphatic drainage.

This therapy is noninvasive and easy for veterinarians to perform. There are relatively few contraindications: the eyes of the therapist and those of the patient require protection from the laser light, and laser therapy should not be used near or on the eye (to prevent retinal damage), on cancerous lesions, over areas of hemorrhage, and over endocrine glands – these are areas where cellular activity should not be stimulated.

Cold laser therapy helps reduce pain and inflammation, and it speeds the healing of injured and inflamed tissues. Frequency of treatment depends upon the condition being treated, as well as whether the issue is acute or chronic in nature. The effect of cold laser therapy is cumulative, with each treatment building upon the last. A rabbit with lumbosacral degenerative joint disease (discopondylosis), for example, might receive treatments as follows: two per week for one to two weeks, then one per week for several weeks, followed by several monthly treatments, and then only once every three to four months or as needed to keep the rabbit comfortable. Every patient and every case is different, and just like with people, overuse of muscles and joints or a newer acute injury might require a temporary increase in frequency. For wound healing, however, the frequency would be determined by healing response because each wound is different. Generally, wounds require two to three cold laser treatments per week for several weeks.

Cold laser therapy is indicated for many health issues in rabbits. At the primary author’s veterinary practice, the therapy has been used with significant success, treating rabbits with arthritis, discospondylosis, skin and ear issues, and cellulitis. Cold laser therapy has also been used both for post-surgical care and for wound healing.

Acupuncture

Rabbits are usually very compliant with acupuncture, especially for points around the head and dorsum (over the back). Distal acupoints located around the legs and feet are more sensitive, so the rabbit is placed in the “C” position to accommodate these points and often held like this for the duration of the needling session.

Acupuncture is a modality that helps with so many issues in both human and animal medicine. It has been an especially great adjunct to Western medicine at the primary author’s animal clinic in helping with pain, anxiety, and stress-associated problems in rabbits, as well as wound healing and gastrointestinal hypomotility and stasis (shutdown). The physiological effects of acupuncture (how the body responds) are created through a series of interactions among the nervous system, endocrine system, and the immune system. Acupuncture helps to open the flow of energy along the body’s natural meridians to decrease pain as well as to increase the pain threshold. By restoring normal energy flow, the organs are able to work more effectively, allowing the rabbit’s body to function better as a whole.

Rabbits tend to respond quickly to acupuncture and tolerate needling sessions well, though they are more sensitive to acupuncture at peripheral acupoints (the points along the meridians where the needles are placed), such as on the feet and legs. Traditional acupuncture is designed to treat the entire patient, rather than symptoms only. Therefore, each time the primary author sees a rabbit at the exotic care center, an individualized treatment plan is developed. Because most patients have a combination of problems, usually the most significant or acute issues are treated first, so the choice of acupoints may change as the more acute problems are minimized or as new issues arise. The primary author often uses herbal therapy to complement the acupuncture treatment, making changes in both as necessary to provide the best support for the rabbit.

Here is Ivy early in her treatments with acupuncture. Her response to her first treatment was mostly in her affect, she was brighter, less anxious and much less painful.

There are many success stories about the use of acupuncture for rabbits. As an example, an eight-year-old Dutch rabbit with a paralyzed left leg and severe arthritic changes in her lumbosacral spine was urinating on herself and exhibiting signs of pain, lethargy, and depression. She could move on her own, but only by pulling herself forward with her front legs; her rear legs dragged behind her.

The onset of her condition was quite sudden: two weeks earlier, the Dutch bunny was quivering and posturing differently with her back legs. At that time, cold laser therapy and MET/CES were administered. She also had pain in the lumbosacral area. Mild elevation of liver enzymes made the use of meloxicam more dangerous, so she was started on buprenorphine and tramadol.

Two weeks later, the Dutch rabbit presented with the “crabbing” motion, using her front legs only to move forward. Before making the final decision for euthanasia, the Dutch was offered acupuncture along with continued pain medication. Her initial response to the treatment was mostly in her affect: she appeared more comfortable (i.e., less pain) and less depressed and was eating better almost immediately. After the second treatment, she was using her right rear leg and hopping about. Her left rear limb showed improvement as well: both deep pain and voluntary movement were noted. In other words, her response to a toe pinch indicated improving neurological function of the limb (in paralysis, such response would be absent). As of eighteen months from the date of this article, the Dutch bunny’s quality of life remained significantly improved. She was able to hop with both rear legs and use her left rear leg to clean her ear. Though she still had some residual urinary issues, the Dutch rabbit was doing very well.

I wish to extend my thanks to Dr. Susan Brown for her review of the article and to Dr. Stephanie Crispin and Gary McConville for their suggestions.

Teresa Bradley Bays, DVM, CVA, DABVP (Exotic Companion Mammal Specialist), practices in Missouri at the Belton Animal Clinic and Exotic Care Center. She is the author of numerous articles and book chapters on exotic animals and is the senior editor and coauthor of Exotic Pet Behavior: Birds, Reptiles, and Small Mammals. Dr. Bradley Bays speaks nationally and internationally on exotic animal medicine and surgery. She is also actively involved with community service as veterinarian for HELP Humane, veterinarian for an animal facility at a domestic violence shelter, and as founder and coordinator of the Pajamas for Foster Kids Program (www.beltonanimal.com for additional information).

Marie Mead has been involved in various capacities with animal rescue, advocacy, and education for over twenty years. She has made a home with special-needs rabbits and other animals, all of them rescues. Author (with collaborator Nancy LaRoche) of Rabbits: Gentle Hearts, Valiant Spirits – Inspirational Stories of Rescue, Triumph, and Joy, Marie has also written rabbit-related stories and articles for other publications. Additional writings have covered topics such as aging and the environment.

]]>Liver (Hepatic) Disease in Rabbitshttps://rabbit.org/liver-hepatic-disease-in-rabbits/
Tue, 22 Jan 2013 19:06:05 +0000http://rabbit.org/?p=12571This article discusses two of the more common liver diseases in rabbits: hepatic lipidosis (fatty liver) and toxic liver damage. Some additional liver diseases are briefly mentioned toward the end of the article.

HEPATIC LIPIDOSIS

Hepatic lipidosis is sometimes referred to as fatty liver disease due to the accumulation of excess fat in the organ. It is usually triggered by anorexia (loss of appetite), which can be caused by many factors, including pain, chronic fear or anxiety, change in diet, dental and other health problems, and inappropriate handling. Onset of the condition can be rapid, and the disease can quickly become life-threatening.

Dr. Tomáš Chlebeček, who has lived with house rabbits and treats many in his practice, shares what happens in the liver when a rabbit is anorexic and stops eating:

Volatile fatty acids are extracted from a rabbit’s cecotropes when they are digested, and some fatty acids are absorbed directly through the cecal wall. When the rabbit’s body is working as it should, the liver processes the fatty acids, mostly for energy, and maintains a constant level in the bloodstream. The liver itself contains a low percentage of lipid (fat).

When a rabbit stops eating, cecotrope output is halted, and glucose and volatile fatty acid production are reduced. The rabbit’s body calls on its fat reserves for energy, transporting those fatty acids to the liver, which is the only organ that can process them. Because the body’s normal chemical processes have been interrupted, the fat begins to build up in the liver (mostly as triglyceride). The cells become overrun, causing production of ketone bodies, which are the intermediate product of fatty acid metabolism, as well as acidosis, which is an abnormal increase in the acidity of the body. The rabbit becomes sick, liver cells continue to fill with fat and start to fail, and the rabbit becomes lethargic. Without timely intervention, the entire liver fails, resulting in death.

Dr. Jason Hutcheson, who treats rabbits every day for individuals as well as for the Georgia House Rabbit Society, adds this:

Bunny parents should be concerned if their rabbit doesn’t eat for as little as twenty-four hours. Waiting much longer to see if the appetite returns is very risky because problems such as hepatic lipidosis can occur in a very short period of time. Unfortunately, it can take weeks or months to correct and is sometimes fatal.

Obese rabbits, who often cannot reach and ingest their cecotropes, are at high risk for hepatic lipidosis because they already have increased fat accumulation in the cells. If an obese rabbit is put on an inappropriate diet and loses weight too fast, he or she can become ill very quickly.

Signs of Hepatic Lipidosis

There are no early warning signs pointing specifically to hepatic lipidosis, and it may occur as either a primary or secondary disease. Obesity creates a greater risk. The warning signals listed below can be seen with hepatic lipidosis but are not exclusive to that disease. Any of these signs warrants a trip to the veterinarian.

Loss of appetite (anorexia) – may be sudden or gradual

Weight loss

Decline in number and size of droppings (feces)

Dehydration

Depression and lethargy

Diagnosis, Treatment, and Prognosis for Recovery

If a rabbit is anorexic, emergency medical care is needed. Depending on the severity of the condition as well as diagnostic tests to be performed, pain medication or sedation may be needed.

A blood panel will reveal whether the rabbit has elevated liver enzymes. Whole-body radiographs and ultrasound help rule out other primary conditions such as other forms of liver disease or cancer. The diagnostic procedures also assist a veterinarian in determining the underlying cause of anorexia, such as tumors in other organs or bladder stones. Sometimes hepatic lipidosis is diagnosed through the exclusion of other disease.

Dr. Peg Frank, who treats many rabbit illnesses and injuries in her practice, advises:

When I see a rabbit who is obese, anorexic, and has elevated liver enzymes, I rule out other illness or injury and then treat for hepatic lipidosis, taking immediate steps to pursue and correct whatever is causing the anorexia.

To get a definitive diagnosis of hepatic lipidosis, a veterinarian has to aspirate tissue from the liver. Needle aspiration is traumatic and painful for the rabbit, further stressing an already seriously compromised animal. The required sedation creates additional risk for the rabbit, especially if obese.

When liver enzymes are elevated – meaning there are excess enzymes in the blood due to leakage from the liver – I forgo a definitive diagnosis of hepatic lipidosis once I’ve ruled out all other causes of enzyme elevation because of the additional stress to the rabbit and the need for immediate treatment.

Anorexia can trigger hepatic lipidosis and it also results in a slowdown of the gastrointestinal (GI) tract, possibly resulting in painful gas build-up. If not addressed, the rabbit may go into stasis (GI shutdown). Therefore, treatment of hepatic lipidosis goes hand-in-hand with treatment of GI problems. Dr. Frank’s protocol includes the following:

Hepatic lipidosis is a very serious illness. If the rabbit is started on emergency treatment soon enough, he or she may recover. If treatment is delayed, the bunny is likely to die of liver failure.

Home Care of a Rabbit with Hepatic Lipidosis

The home care regimen worked out with the veterinarian will be based on the condition of the rabbit as well as the underlying cause of anorexia. Treatment for GI hypomotility (slowdown) or stasis will continue until the rabbit is eating and depositing fecal pellets again.

It may be necessary to continue syringe-feeding the bunny, and Dr. Frank prefers a fiber-based food such as Critical Care. Keeping a bunny hydrated is imperative. Sometimes a rabbit’s interest in foods will be stimulated by fresh aromatic cooking herbs (e.g., cilantro, oregano, parsley).

When the rabbit is eating normally again, it’s very important to watch food intake. If there is more than one rabbit, it may be necessary to separate the bunnies to ensure that the ill rabbit eats his food. Free-feeding of pellets is never recommended. For an obese rabbit who is not eating the proper amount of grass hay and leafy greens on a daily basis, the quantity of processed pellets must be reduced very slowly; weight loss will occur at a slower pace. (Reference the article “Overweight and Underweight Rabbits.”)

The long-term goal is to get the rabbit on a good diet consisting of grass hay, green leafy vegetables, and limited amounts of grass-hay-based pellets. Foods high in fat (e.g., seeds), starch (e.g., pretzels, crackers), and sugars (e.g., dried fruit, yogurt drops) should not be fed. Exercise is critical to weight loss; piquing the rabbit’s interest to move around will assist in safe and healthy weight reduction.

TOXIC LIVER DAMAGE

A rabbit’s liver may be affected by toxins from a variety of sources, including the following:

Certain medications (including analgesics for pain)

Molds from bedding and hay, as well as other foods (e.g., pellets, cereals)

Plants (including house plants)

Metal-based products such as lead-based paint

Household and other chemical solutions

Ingested toxins are extremely dangerous for rabbits. They do not vomit and so are unable to immediately rid their bodies of these deleterious substances.

Mold in processed (pelleted) food or hay may sometimes be hard to detect, but the fungal organisms can cause gastroenteritis, neurological disease, and liver toxicity. Fungi may also depress the immune system, which, in turn, predisposes a rabbit to other health problems.

In addition, use of aromatic wood shavings (e.g., cedar litter) may affect the liver, especially if the rabbit is in a poorly ventilated area. When the rabbit inhales, the phenols from the shavings are passed from the lungs to the blood and filtered through the liver.

Signs of Liver Damage from Toxins

As is the case in many rabbit illnesses, the signs of liver damage are nonspecific and may be seen with other diseases.

Jaundice (yellow discoloration of the white part of the eyes and mucous membranes of the mouth)

Neurological signs (e.g., lack of coordination, confusion)

Diarrhea (when all the droppings are liquid, not just soft or mushy cecotropes)

Diagnosis, Treatment, and Prognosis for Recovery

Blood work will reveal elevated liver enzymes. If the rabbit has become anorexic, emergency medical treatment is required. Dr. Hutcheson advises:

Depending on the cause, different medications may be prescribed. If a toxic substance has been ingested, a detailed history is critical to treatment because an antidote is based solely on the ingested toxin.

In addition to the liver, other organs in the body may be affected. For example, some molds produce toxic compounds (aflatoxins) that cause a painful inflammation of a rabbit’s gastrointestinal lining.

The prognosis for recovery will depend on the situation, the rabbit, and the cause of the problem. The liver is a resilient organ, capable of regenerating itself; if it is not too badly damaged, the prognosis is good. Dr. Hutcheson advises:

Feeling an abnormal liver during physical exam tells me there is a reason to look further with more diagnostics. The additional diagnostics will help me determine what is going on. Other signs of liver disease are elevated liver enzymes on blood work or visualizing an abnormally sized or shaped liver on radiographs or ultrasound. The very definitive way to assess what type of disease is present would be with a liver biopsy.

After the rabbit has returned to health, the veterinarian may want to repeat the blood work to confirm that liver function has returned to normal.

Home Care of a Rabbit with Toxic Liver Damage

The veterinarian will prescribe a home-care maintenance plan based on the diagnosis of the liver disease. In addition, caregivers can take preventive measures: Replace aromatic shavings with a litter known to be safe for rabbits, eliminate access to toxic substances, make houseplants inaccessible, feed fresh vegetables that have not been chemically treated, and store grass hay and pellets in a clean, dry place.

More specifically, litters that do not contain phenols and that a rabbit will not eat are recommended. Toxic chemicals and other household, garage, or work products should be safely contained, and access to potential and known poisonous plants should be blocked. Help ensure against molds/fungi by keeping bedding clean and dry, checking expiration dates on food packages and discarding outdated ones, and properly storing all food. Do not repeatedly freeze, bring to room temperature, and refreeze pellets. Instead, freeze the pelleted food in small bags and take them out as needed. Mold growth is encouraged by dramatic changes in temperature. Therefore, both hay and pellets are best maintained at as constant a temperature as possible.

OTHER LIVER DISEASES

A variety of neoplasms may affect the liver and/or bile ducts, some with grave consequences. Trauma can also be a cause of liver disease; for example, if a rabbit is dropped or falls or if a rabbit suffers abuse (e.g., kicked, punched).

Coccidia, a one-celled parasite that is common in young rabbits, can invade the liver (hepatic coccidiosis). This condition is more common when rabbits are subjected to unsanitary living conditions and inadequate disease control. Signs of hepatic coccidiosis can include weight loss, chronic soft stools (i.e., feces, not just the cecotropes), poor hair coat, and decreased appetite. Your veterinarian will run diagnostic tests if this parasite is suspected.

ADDITIONAL CONSIDERATIONS

In addition to the “Overweight and Underweight Rabbits” article (referenced above), read articles posted on this website regarding diet and other health-related topics. Caregivers may want to consider supplementing their rabbit’s care with alternative therapies, some of which are addressed in separate articles on this website. There are times when combining the expertise of both standard and alternative treatments offers the best supportive care.

When researching complementary treatments, be aware of training and qualification requirements and give careful consideration to the health, nature, and needs of your rabbit. Be clear and realistic about your expectations and goals for treatment, which should prioritize your rabbit’s comfort and quality of life.

I wish to extend my sincere gratitude to Drs. Tomáš Chlebeček, Peg Frank, and Jason Hutcheson for sharing their expertise in this article and to Dr. Susan Brown for her overall review of the article. Warm thanks also to Cheryl Abbott, Sandi Ackerman, Heidi Anderson, Dr. Stephanie Crispin, and Gary McConville for their suggestions. – Marie Mead

Marie Mead has been involved in various capacities with animal rescue, advocacy, and education for over twenty years. She has made a home with special-needs rabbits and other animals, all of them rescues. Author (with collaborator Nancy LaRoche) of Rabbits: Gentle Hearts, Valiant Spirits – Inspirational Stories of Rescue, Triumph, and Joy, Marie has also written rabbit-related stories and articles for other publications. Additional writings have covered topics such as aging and the environment.

Tomáš Chlebeček, DVM is a former aerospace engineer who became a veterinarian as a result of his association with the Colorado House Rabbit Society. He received his degree from Colorado State University in 1999 and practiced at the Makai Animal Clinic in Kailua, Hawaii, before moving to the Czech Republic.

Peg Frank, DVM obtained her degree from the University of Minnesota and completed an internship at the University of Prince Edward Island-Atlantic Veterinary College in Canada. Dr. Frank practices at Cottage Grove Animal Hospital in Cottage Grove, Minnesota.

Jason Hutcheson, DVM is the owner of For Pet’s Sake, the Avian and Exotic Animal Hospital of Atlanta. After graduating in 1998, he joined the veterinary staff at For Pet’s Sake and eventually purchased the practice from Dr. Mimi Shepherd in 2006. He treats rabbits every day for individuals and for the Georgia House Rabbit Society and has written articles for their newsletter.

BIBLIOGRAPHY

My sincere thanks to the veterinarians named in this article for sharing their expertise during personal interviews and for their additional feedback. In addition to House Rabbit Handbook: How to Live with an Urban Rabbit, the following list of publications, although by no means comprehensive, may assist those who desire additional research.

]]>Disorders of the Cecumhttps://rabbit.org/disorders-of-the-cecum/
Tue, 22 Jan 2013 18:13:27 +0000http://rabbit.org/?p=12561The healthy functioning of the cecum is critical to the overall health of a rabbit. Gaining an understanding of how this large organ works – and what causes disruption – will help caregivers monitor their rabbits’ health, detect early signs of cecal disorder, and take steps to prevent a bunny’s condition from worsening.

The primary author has a special interest in cecal function because of her rescued rabbits. Most would be considered “special needs,” and it was not uncommon to see them initially producing soft cecotropes. One of them, elderly and very ill, presented with a large soft mass that looked as though it had been dispensed from a soft-serve machine, complete with swirl on the top. Another presented with what is commonly referred to as “cow pile syndrome.” In both cases, the right diet returned them to a level of health that allowed them to live the remainder of their lives as normal rabbits.

Overview of article. This article covers the following topics: How the cecum functions in a healthy rabbit, including indigestible fiber, digestible fiber, and cecotropes. Prevention of cecal disorders. Cecal motility disorders. Signs of three stages of cecal motility disorders, including abnormally soft cecotropes, cecal hypomotility (slowdown), and cecal impaction (stasis). Treatment and prognosis for recovery from cecal motility disorders. Home care of rabbits with cecal motility disorder. Enterotoxemia, including signs, treatment and prognosis, and home care; the disease is related to cecal motility disorders in that it also affects the gastrointestinal tract. Brief mention of cow pile syndrome, which shares some similar signs with cecal disorders, is included at the end of the article.

At the end of the article is a chart that sums up the various disorders and signs.

HOW THE CECUM FUNCTIONS IN A HEALTHY RABBIT

Rabbits have a complex and efficient gastrointestinal (GI) physiology that allows them to digest materials that are indigestible to non-herbivore species. The stomach and small intestine alone are not able to extract all the nutrients from the fibrous plant material that is a rabbit’s primary food source. As a result, the thin-walled cecum – the largest organ in a rabbit’s abdomen – serves as a fermentation chamber, enhancing nutrient retrieval. The cecum is a sizable pouch that has its opening at the junction of the large and small intestines. It uses primarily bacteria, along with some protozoa and fungal (yeast) flora, to convert food into the amino acids, vitamins, and volatile fatty acids needed for a healthy existence.

Indigestible Fiber: Its Key Role

Food that passes into the large intestine (colon) is separated into two parts: indigestible fiber and digestible fiber. Unlike many other species, in which liquid is removed from the contents of the large intestine, the rabbit actually secretes fluid into the upper part of the large intestine to allow sorting of the two fibers. The indigestible fiber stimulates the movement and mixing of the intestinal contents; therefore, fiber must be ingested regularly to keep the digestive system working as it should. The indigestible fiber is collected and then pushed into the second half of the colon where water is removed, leaving the small, dry, nearly odorless fecal pellets that are excreted as waste.

Digestible Fiber and Cecotropes (UK spellings include cecotrophs and caecotrophs)

In contrast, digestible fiber, along with some fluid, is moved backwards from the upper part of the colon into the cecum. (Reference the illustration included in Marinell Harriman’s House Rabbit Handbook.) This material is broken down by the cecal flora, and some of the resulting nutrients are absorbed directly through the thin cecum wall. The remaining material is turned into cecotropes: small packets of tiny-bodied, nutrient-rich flora. (Note that cecotropes are sometimes informally referred to as cecals; however, the word cecal is appropriately used to refer to processes involving the cecum.)

Several hours after eating, contractions of the cecum and colon move the cecotropes out toward the anus. Receiving a neurological signal that the cecotropes are coming, the rabbit turns his attention to the anal area and eats the cecotropes directly (a process called cecotrophy); they are swallowed whole. Few caregivers ever see the cecotropes, as it looks like the rabbit is simply grooming his anal area.

Cecotropes are dark green and have a distinct odor and a small grape-cluster appearance. They are covered in a thin layer of mucus to provide initial protection to the bacteria from the low pH stomach acids. Once eaten, the cecotropes are gradually broken down in the digestive tract and the nutrient-laden cecal flora are assimilated.

Rabbits should always be allowed to eat their cecotropes. These food capsules are not fecal waste; they are a critical part of the diet. Though rabbits are crepuscular (meaning they are most active at dawn and dusk), house rabbits react to variable lighting and their human’s schedule, so they may graze throughout the day and produce cecotropes any number of times. (Thus, they are not really “night droppings” as sometimes thought.)

Healthy rabbits consume all their cecotropes. However, consumption can be influenced by the rabbit’s diet. For example, a protein-rich diet (such as one high in alfalfa) may result in a rabbit ingesting fewer cecotropes; thus, you may find them in the litter box along with regular feces. If cecotropes are not ingested, the rabbit may experience dietary insufficiencies.

Additionally, note that a rabbit may not eat cecotropes due to dental or other oral pain as well as obesity or restricted movement (e.g., spondylosis) that prevents the bunny from physically reaching the anus to eat the cecotropes.

Before starting the discussion of cecal disorders, it should be noted that caregivers can help protect their rabbits against the diseases, which can be life-threatening.Throughout this article, the important role of diet is mentioned in both the cause and treatment of cecal disorders. Diet is also the best protective measure against all gastrointestinal (GI) tract disease, and that includes disorders of the cecum and enterotoxemia. A rabbit’s diet is ideally composed of high-fiber, low-energy foods.

The discussion below includes information about foods that disrupt the proper working of a rabbit’s GI tract as well as foods that enable it to function as it should. Other causes of cecal disorders (e.g., ingestion of foreign material, antibiotics) are also mentioned, the knowledge about which will help caregivers take proactive steps to protect their rabbits.

CECAL MOTILITY DISORDERS

This section of the article addresses three cecal motility disorders; most disorders of the cecum will eventually lead to dysbiosis (imbalance of the microbial flora in the cecum and GI tract).

When a rabbit’s GI tract works as it should, cecotropes are produced in a rhythmic fashion and consistently eaten by the bunny. However, when the process does not work normally, disruption in cecal motility results. It can be caused by a variety of factors, including pain, toxins (including some antibiotics), ingestion of foreign materials, disorders of other parts of the gastrointestinal tract, and environmental or physical stress (such as extremes of temperature, poor sanitation, and lack of exercise). In addition, our domestic rabbits retain the prey flight-response of their forebears and the stress of real or perceived danger can adversely affect digestion, cecotrope production, and gut motility.

However, the most common cause of cecal motility disorders is food, especially a diet too rich in carbohydrates – including starchy vegetables, fruits, and grains – and lacking in fiber. Dr. Scott Stahl, who treats many rabbits at his exotic animal practice, advises:

Rabbits are herbivorous and their proper diet includes high-fiber, low-energy foods such as grass hay and leafy greens. The importance of fiber cannot be emphasized enough: it’s what is moved into the cecum for fermentation and further digestion, forming into the nutrient food called cecotropes. Fiber affects cecotrope consistency as well as the rabbit’s appetite for them.

When a rabbit is fed appropriately, a balance of bacteria in the cecum works slowly to break down fibrous plant foodstuffs, providing volatile fatty acids for energy as well as amino acids, vitamins, and particular enzymes.

In contrast, when rabbits are allowed free access to commercial pellets (including those containing dried fruits, grains, and/or legumes) or simple carbohydrate snacks (such as crackers, toast, or cookies), the cecum often can no longer function properly. These high-starch foods – which are also highly fermentable – are quickly broken down by the cecal bacteria, resulting in cecal gas, possible overgrowth of dangerous bacteria, and an imbalance in the delicate cecal flora. An irregular production or abnormal formation of cecotropes is often the result.

Maintaining the balance of flora in the cecum is critically important to a rabbit’s health. Dysbiosis can result in problems serious enough to cause illness and death.

Stages and Manifestations of Cecal Motility Disorders

There are various stages and manifestations of cecal motility disorders. Dr. Susan Brown, who has been an exotic animal veterinarian for over thirty years, with a special interest in rabbits, explains:

When cecal dysbiosis occurs, there is often a change in the pH of the cecal contents, thus changing the balance of cecal flora. The timing of contractions in the large intestine is interrupted, resulting in food particles not being sorted and broken down as they should be. The cecum then “dumps” contents randomly instead of producing nicely formed cecotropes. This dumping usually results in relatively formless, “pudding like” cecotropes, often with foul smell. The rabbit is unable to eat them, and they may end up on the floor or pasted to the rabbit’s rear end. It is not known for sure, but there may also not be the normal “brain trigger” to tell the rabbit that the cecotropes are coming.

Not all rabbits with cecal dysbiosis will exhibit obvious soft or pudding-like cecotropes. Some rabbits will have a gradual decline in appetite and develop smaller and smaller waste droppings, ending eventually with a complete cessation of food intake and a shutdown (ileus) of the intestinal tract and cecum. Gas will build up, fluid will accumulate, and the rabbit will soon be in a life-threatening situation.

Another scenario that occurs less frequently is when a rabbit eats less, then stops eating, producing mucus instead of cecotropes. Eventually the rabbit will also develop a life-threatening ileus, which is the shutdown of movements in the GI tract.

Dr. Tomáš Chlebeček, a companion animal veterinarian who also has a special interest in rabbits, adds this:

In a well-functioning digestive system, simple sugars and starches are removed by the small intestine before the food reaches the cecum. All rabbits have low levels of pathogenic [potentially harmful] bacteria in the cecum. As long as they are eating a low carbohydrate diet, these bacteria are not harmful.

However, if a rabbit eats high-carbohydrate foods, there will be glucose in the cecum, which will allow pathogenic bacteria (primarily Clostridium spp, sometimes E. coli) to flourish and produce toxins that can lead to enterotoxemia, diarrhea, and death.

SIGNS OF THREE STAGES OF CECAL MOTILITY DISORDERS

Three general stages of cecal motility disorders are discussed in this section: abnormally soft cecotropes, cecal hypomotility (slowdown), and cecal impaction (stasis). However, as previously noted by Dr. Brown, a rabbit will not necessarily proceed through each stage.

In addition, cecal motility disorders may be gradual and progressive. Thus, familiarity with the signs of the various stages can be helpful, keeping in mind that there is overlap between the stages and that individuality affects how a rabbit presents with the condition.

Additionally, cecal impaction is different from gastrointestinal (GI) blockage, though some of the signs are similar. Both are life-threatening conditions. The signs for cecal motility disorders are non-specific; they may be indicative of some other problem.

Abnormally Soft Cecotropes

Although appetite and activity level may appear normal, the caregiver may notice the following signs in addition to the abnormally soft, possibly gooey, cecotropes:

Irregular cecotrope production (in number and timing)

Occasional mucus from the anus (without the usual accompanying cecotropes)

Inflammation around anal area (due to accumulation of cecotropes)

Gradual weight loss

Poor coat (e.g, scruffy, sparse, dull)

The term “poopy butt” is often used to describe a rabbit who excretes soft stools that soil the hind end. However, this messiness is not generally caused by fecal matter but is due to liquid or malformed cecotropes matting the fur. The mucous covering of the cecotropes makes them sticky and hard to remove.

Cecal Hypomotility (Slowdown)

As already stated, not all rabbits with a cecal motility disorder will present with pudding-like cecotropes. It may be that a rabbit reacts with loss of appetite and subsequent slowdown of gut motility, which leads to the life-threatening shutdown of both the intestinal tract and the cecum.

In addition to inappropriate diet, cecal slowdown may be caused by ingestion of a foreign material such as cat litter (e.g., wheat, corn, clay), bulk-forming products such as psyllium, carpet material, seeds, or dried legumes. In addition to causing imbalance, some of the materials absorb water, which is crucial to the working of the cecum and upper part of the colon. Regardless of origin, unhealthy or foreign materials can become lodged in the cecum or they may create cecal imbalance. In addition, toxins such as heavy metal or inappropriate antibiotics can cause cecal flora changes.

When the cecum cannot empty properly, it no longer functions normally. The rabbit will start to become dehydrated.

Cecal hypomotility (slowdown), which can lead to serious problems, results in fewer cecotropes – something not easily observed by the caregiver. Signs to watch for include those listed above for obviously soft cecotropes as well as:

Decline of normal appetite and water intake

Picking at food; dropping uneaten food

Smaller and fewer fecal pellets

Another sign may be lumps in the cecum; however, a rabbit-knowledgeable veterinarian should make this determination. Extreme caution needs to be taken when feeling the internal organs of a rabbit with a potential cecal problem because the thin-walled cecum could be bruised or ruptured with overly aggressive palpation.

Cecal Impaction (Stasis)

If cecal hypomotility is allowed to continue, the cecum will become impacted – the contents will become dehydrated and there will no longer be the normal mixing and movement of material in and out of the cecum. This condition results in a serious imbalance of the cecal flora, and the rabbit becomes gravely ill. Cecal impaction (confirmed with radiographs) will result in a slowdown and subsequent stasis of the GI tract.

Not every rabbit will exhibit all of the following advanced signs (some of which also apply to intestinal obstruction):

Dehydration

Complete loss of appetite (anorexia)

Cessation of cecotropes

Cessation of fecal output

Silent gut or excessive gut sounds

Pain (due to build-up of gas)

Low body temperature

Weight loss

Distended abdomen

Note that abdominal abnormalities (e.g., shape, distension) can be caused by something other than cecal impaction, for example, certain cancers as well as liver and cardiac diseases.

TREATMENT AND PROGNOSIS FOR RECOVERY FROM CECAL MOTILITY DISORDER

Treatment and Prognosis for Recovery: Abnormally Soft Cecotropes

Treatment for a cecal motility disorder that manifests as abnormally formed cecotropes is based on the appropriate diet for a rabbit. Dr. Brown advises:

A diet that most closely approximates that of a wild rabbit is healthiest for domestic rabbits. Unlimited grass hay and a measured amount of green leafy vegetables should be offered daily. Processed pellets are unnecessary for most rabbits if they eat quality mixed grass hay and a variety of leafy green foods.

If a rabbit with soft cecotropes is overweight, it’s safe to discontinue feeding pellets only if he or she is freely eating grass hay. However, if the rabbit is not eating hay or not eating it in the quantity needed, then a gradual reduction in the quantity of processed pellets is necessary to prevent hepatic lipidosis. If the pellets are alfalfa-based, they should be replaced by grass-hay-based pellets as soon as possible. This can be done by mixing the two types and gradually reducing, then removing, the alfalfa-based pellet. In all cases, high carbohydrate or sugary snacks (e.g., grain-based foods or cereals and fruit, both dried and fresh) should be discontinued immediately.

If the rabbit has overly soft cecotropes and the problem is diet-related, the prognosis for recovery is excellent as long as dietary guidelines are followed. Dr. Brown offers this:

My experience with several hundred rabbits who have had pudding-like cecotropes – but were otherwise active, alert, and medically normal – is that feeding a diet of only grass (not alfalfa) hay usually turns them around in a week. If the problem has been going on for months or the rabbit doesn’t browse the required amount of hay (making it necessary to feed some pellets), then the turn-around time may be longer.

Once the rabbit stops producing the obvious soft cecotropes for a full week – meaning his body is now producing cecotropes normally – I gradually add in one leafy green food every three days until the rabbit is eating a nice variety. Ideally, I like to have the rabbit eating three or more different types of leafy green foods during the week (the more fibrous greens rather than soft salad greens).

It can take up to two months for the cecal flora to completely return to normal, particularly if the rabbit has had abnormal cecotropes for weeks or months prior to treatment. I advise my clients to never feed any high-carbohydrate (especially grain-based) foods again. If pellets are to be eventually introduced, I recommend that only grass-hay-based (not alfalfa-based) pellets be fed on a very limited basis; the food should be devoid of grains. Some rabbits can be successfully fed small amounts of dried or fresh fruit if they are introduced gradually, with the cecotropes remaining normal. However, if soft cecotropes are produced again within twelve to twenty-four hours of the introduction of any food into the diet, immediately discontinue that food.

As already noted, a gradual change in pellet amount or kind (alfalfa-based to grass-hay-based) may have to be done gradually to prevent hepatic lipidosis. For additional information, reference “Liver (Hepatic) Disease in Rabbits,” posted on this website.

Treatment and Prognosis for Recovery: Cecal Hypomotility

Treatment for the early stage of cecal hypomotility (slowdown) leading to impaction is much the same as for ileus, the cessation of GI tract movement. Unfortunately, the rabbit may not always be brought to the animal hospital early in the condition. Dr. Bill Guerrera, who treats many rabbits from the Colorado House Rabbit Society, shares his experience:

At first, the rabbit may act very normal and is eating and drinking. The condition may involve only a slight decrease in size and/or frequency of stool production, and gut sounds may be normal. Because he’s active and alert, the caregiver often assumes the rabbit’s health is okay.

Contents of the cecum are normally semifluid. So when I palpate doughy contents in the cecum instead, my diagnostics may include radiographs and blood work to assess the severity of the situation. I also want to rule out other systemic illness or disease. Though it’s not always possible to determine the initial cause of cecal hypomotility, successfully returning the rabbit to health hinges on stimulating the gut to work again.

In the early stages of cecal hypomotility, the rabbit is usually healthy enough to be at home, and he’s generally less stressed there as well. Before the rabbit is dismissed from the hospital, sterile fluids are given subcutaneously to help soften the mass and get it moving. I work out a treatment protocol for the caregiver that includes additional hydration if necessary, and some caregivers are skilled in giving fluids at home. I also provide guidelines for a diet that is high in fiber and water content (Oxbow Critical Care™ is a popular choice). Current research indicates that return to health hinges on fluids and fiber.

If there are signs of pain, I prescribe meloxicam (Metacam®), a COX-2 selective NSAID [nonsteroidal anti-inflammatory drug]. Prokinetics (motility drugs) may be considered, though scientific trials are lacking; opinions on which drugs are most effective vary. Some veterinarians may prescribe probiotics for rabbits on antibiotics for extended periods of time, but the efficacy of presently available probiotics is currently unknown.

Because cecal impaction is a serious threat, I want to see the rabbit respond to treatment within twenty-four hours. If there is no improvement or if the rabbit’s temperature drops, it’s vital to reexamine the situation.

If the rabbit’s digestive system is responsive, I like to perform a recheck within the week to make sure the cecum is emptying. If it empties and the flora balance is restored, the prognosis for the rabbit is very good. I encourage the client to give the recovering rabbit gentle tummy massages and to allow him to be active.

If a rabbit is not treated early, the caregiver will suddenly notice changes in the rabbit’s behavior and responsiveness. Because cecal impaction and intestinal obstruction share some of the same signs, it’s critical that the veterinarian determine the cause of the rabbit’s problems to ensure correct treatment and follow-up.

Cecal impaction is extremely serious. Though the rabbit may look fat, due to abdominal distension, he or she may be very emaciated and most likely unable to absorb the nutrition needed to maintain health. Acute dehydration may lead to additional problems. Dr. Chlebeček explains:

When a rabbit is severely dehydrated, the peripheral circulation shuts down in order to maintain circulation to internal organs and the brain. That means that subcutaneous fluids are not absorbed quickly enough to do much good. Administration by IV (intravenous, by vein) or IO (intraosseous, into the bone marrow, e.g., of the femur) gets fluids into a severely dehydrated or otherwise critically ill rabbit.

An analgesic for pain will also be required. Some individuals feel Banamine® (flunixin meglumine) is superior for GI pain. It is an injectable that can be given orally if mixed with something palatable. However, the drug is not without significant risks, as Dr. Chlebeček mentions:

Banamine® has a negative effect on prostaglandins, which are necessary for rabbits to make cecotropes and to get them out of the cecum. In addition, the drug can destroy the stomach lining and damage the kidneys, especially in a dehydrated rabbit. When there is dehydration and shutdown, buprenorphine (an injectable morphine derivative) may be more appropriate. (Meloxicam works well in well-hydrated rabbits.)

This negative effect on prostaglandins, a group of hormone-like substances, is an important consideration. Derived from amino acids, they affect a wide range of the rabbit’s physiological functions, including metabolism, smooth muscle action, and nerve transmissions.

Cecal impaction does not mean a rabbit cannot recover. Dr. Guerrera says that he’s had success emptying the cecum:

Fluids are critical to the working of the cecum, so hydration is the key. Fiber is second in importance. Cecal contents have to be softened up, and then fiber helps get things moving again.

These rabbits may have a chronic history of misshapen stool, but once the impaction is relieved I’ve seen rabbits return to living an active, normal life. I like to monitor them closely because once the cecum has been stretched, it potentially loses tone and is more flaccid than it should be.

Rabbits who have had cecal impactions in the past are more likely to develop problems in the future: the cecum may fill up again. Proper nutrition is a must for these rabbits to decrease the probability of recurrence.

There are times when the cecum does not empty and the rabbit is in a life-threatening situation. Dr. Guerrera offers:

Though I’ve seen rabbits with distended cecum and cecal hypomotility go for months without apparent clinical signs – they are eating, active, and maintaining weight – there generally comes a downturn. I become very concerned when a rabbit is not responding to treatment and starts to have diarrhea, lethargy, and weight loss.

Sometimes the cecum will not empty. The decision to go to surgery is never easy. For most veterinarians, surgery into the cecum is the last resort; thus, it is carried out primarily on critically ill patients. The cecum itself is a paper-thin bag of bacterial contamination and does not hold sutures well. Even if surgery is successful, there is always a risk of postoperative sepsis [life-threatening internal infection]. The technically difficult procedure on a critically ill patient equals a poor success rate. If the rabbit does survive the surgery, there is a chance the cecum may not return to normal function. I would also have concern about the long-term prognosis for the rabbit.

HOME CARE OF A RABBIT WITH CECAL MOTILITY DISORDER

A rabbit who has any signs of cecal motility disorder should be checked by a veterinarian experienced with rabbits to make sure there is no underlying disease. Since the condition can also result from other stress factors, a careful review of known stressors will aid the caregiver in making necessary changes to the rabbit’s environment. Any change to the rabbit’s environment, even something as seemingly simple as a change in routine, can potentially result in health problems.

The information contained in the sub-section immediately below applies to the whole of this section, though a veterinarian may provide specific guidelines for feeding pellets and leafy greens, depending on the condition of a rabbit.

Home Care: The Rabbit with Abnormally Soft Cecotropes

When a bunny has soft, poorly formed cecotropes, it is recommended that caregivers discuss the daily feeding regimen with a veterinarian who is knowledgeable about the appropriate diet before making major changes.

If the rabbit who has gooey cecotropes grazes freely on hay throughout the day, Dr. Brown’s guidelines (provided above) will help clear up a diet-related problem. Dr. Angela Lennox, who has practiced exotic animal medicine exclusively for more than twenty years and is past president of the Association of Exotic Mammal Veterinarians, concurs:

Hay drives the gastrointestinal tract. I have seen soft mushy cecotropes cured with a temporary all-grass-hay diet, then reintroduction of limited leafy greens, so many times that I’m convinced of this care regimen.

However, if quality grass hay is unavailable or if a rabbit only nibbles hay or doesn’t seem to like it at all, the rabbit has to be treated differently, as Dr. Brown indicates:

Rabbits who do not freely graze on hay can be maintained on grass-hay-based pellets and leafy greens. However, some rabbits who are producing abnormal cecotropes will not completely return to normal if fed any pellets, even grass-hay-based. This may be due to a starch or protein content in the pellet that is still too high for that individual rabbit.

Caregivers can usually entice their rabbits to eat hay by offering variety and interest, perhaps sprinkling on an aromatic cooking herb for example. Though long-fiber hay is preferable, timothy-based hay cubes are an option.

Offering a variety of grass hay (timothy, orchard, brome, oat) may create interest and is healthiest for most adult rabbits. Note that alfalfa is often mixed in with orchard grass, so it is wise to ask about content before purchasing. Good quality hay should be fed in long-fiber form (i.e., not cubed or chopped up) whenever possible. If you have a rabbit who refuses hay, query rabbit-savvy people about their successes in getting a rabbit to eat it. Dr. Chlebeček cautions that overfeeding pellets and other treats (including fruits and high-sugar vegetables such as carrots) generally results in poor hay consumption.

For those rabbit guardians who are concerned that leafy vegetables may be the cause of abnormal cecotropes, Dr. Brown advises that true vegetable intolerance is rare. Dr. Lennox offers additional explanation:

A rabbit who doesn’t seem to do well with green leafy vegetables may have a genetic intolerance. However, problems are most often caused by previous damage from chronic inappropriate diet and lack of exercise. The focus should be on coarse fibrous plant materials [grass hay].

After the rabbit stops producing the pudding-like cecotropes and green leafy vegetables are reintroduced, Dr. Brown recommends that high-fiber greens (e.g., kale) be included in the selection because of their vitamin content, especially Vitamin C. Softer greens (e.g., romaine lettuce) and cooking herbs such as parsley and mint add variety. Freshly pulled grass (not clippings) and some other native plants (e.g., dandelion greens) that are free of fecal and chemical contamination can also be fed; they have the added benefit of being more fibrous than store-purchased greens.

If the rabbit won’t eat large amounts of hay and holds out instead for the greens, Dr. Lennox advises caregivers to reduce the quantity of greens. Grass hay is most important for the health of the rabbit.

Home Care: The Rabbit with Cecal Hypomotility

Dr. Guerrera’s home-care program for a rabbit suffering from early-stage cecal hypomotility includes fluids and a diet high in fiber. He monitors the rabbit very closely and asks the client to regularly weigh the bunny.

To help move contents out of the cecum, very gentle massage to the belly may be beneficial, depending on the condition. However, extreme caution is necessary so as not to damage or rupture the cecum.

Regarding diet, Dr. Guerrera adds:

The faster the rabbit returns to eating grass hay, the better. If I suspect a nutritional cause, I usually have caregivers slowly introduce green leafy vegetables one at a time every three to five days. If a rabbit prefers greens over hay or is not eating enough hay, then I advise caregivers to be very restrictive with greens. In all cases, the emphasis remains on high quantities of quality grass hay.

Home Care: The Rabbit with Cecal Impaction

A rabbit who suffers from cecal impaction generally will not be returned home until he is no longer in critical condition. Your veterinarian will provide the at-home treatment plan.

Since stress often plays a role in both gastric and cecal stasis, as a preventive measure the guardian should protect the bunny from items that could increase the likelihood of intestinal problems: house plants (many are toxic), cat litter, cat and dog foods, and foreign materials (such as carpet fibers) that a rabbit might chew and ingest. In addition, having a furred companion aids rabbits when they are ill and helps reduce boredom in healthy rabbits, reducing the desire to chew (and potentially reducing ingestion of harmful substances).

ENTEROTOXEMIA

Enterotoxemia, a life-threatening disease, results from toxins produced by specific bacteria that overgrow in a rabbit’s GI tract. These toxins are absorbed into the bloodstream and affect many organs in the rabbit’s body, often resulting in death in a very short time. Young rabbits, especially those newly weaned, are especially susceptible to the disease when they are fed a high-starch diet because their digestive system does not yet have the normal amounts of microbial flora, as does that of a healthy adult rabbit. However, Dr. Brown advises that any rabbit, especially those fed a high-starch or high-sugar diet or those on inappropriate antibiotics, can develop enterotoxemia.

Essentially, the disease is a poisoning of a rabbit’s system, and it is caused by the overgrowth of pathogenic bacteria, notably Clostridium spiroforme and E. coli. As noted previously by Dr. Chlebeček, all rabbits house low levels of pathogenic bacteria in their body. In a healthy rabbit, the organisms live in the intestinal tract without causing problems. However, under certain conditions the microorganisms proliferate, producing rapid onset of severe illness.

Diet plays a major role in setting up conditions favorable to the pathogenic bacteria. Dr. Stahl mentioned that high-starch or refined carbohydrate foods (e.g., crackers, cereals, bananas) are highly fermentable. Pelleted foods that are cereal-based or that contain grain fall into this category (read the label). Rapid fermentation in the cecum upsets the pH, creating an environment more hospitable to dangerous bacteria. Compounding the problem is the lack of fiber; the rabbit is not eating enough grass hay, which means that the cecum does not empty as it should.

Thus, poor diet plays a major role in the disease. Stress and inappropriate antibiotics may also be factors. Dr. Brown shares additional information:

Anytime the pH of the cecum is altered, a rabbit is at risk for enterotoxemia. Though the condition can affect more than the cecum, the cecum is key in the initiation of the disease. Clostridium and E. coli produce toxins that are absorbed through the cecal wall, essentially poisoning the body.

Inappropriate diet is certainly a major factor, and in young rabbits it is the most prevalent cause of enterotoxemia. Stress, including pain, can be a contributing factor because acute stress can upset normal flora balance and gastric function. Antibiotics can also put a rabbit at high risk, especially oral administration of those contraindicated for them, such as clindamycin, erythromycin, penicillins, or cephalosporins. It must be noted that although the disease can cause rapid decline, when enterotoxemia is caused by inappropriate antibiotics, whether administered as a single dose or more long-term, a rabbit may not succumb until many days after the administration of the medication. Therefore, the cause of death may not be obvious.

Rabbits have a very high mortality rate with this disease, and it can happen very suddenly. The more chronic form of it is mucoid enteropathy. This painful, life-threatening condition, also caused by imbalance of the cecal flora, results in an impacted cecum. Fecal pellets are generally absent; instead, the rabbit produces and eliminates excessive amounts of mucus.

Signs such as diarrhea, hypothermia, and shock are very serious. Some rabbits may look healthy, but succumb rapidly. Death from enterotoxemia can result within hours.

Treatment and Prognosis for Recovery from Enterotoxemia

A rabbit exhibiting signs listed above needs emergency treatment; it is likely he will require hospitalization. Emergency treatment generally includes stabilization of the rabbit’s temperature, subcutaneous or intravenous fluids, pain medication, prokinetics (motility drugs), and syringe-feeding of a high-fiber food (e.g., Critical Care™). There are anecdotal reports about the positive effects of probiotics, and a veterinarian may incorporate them into the treatment plan.

If the rabbit is young, the chances for recovery are not as good, especially if the bunny is newly weaned and exhibiting the most serious signs of the disease. Adult rabbits are somewhat less likely to succumb to the disease, especially if treated early, put on the appropriate diet, and any inappropriate antibiotic is stopped. A low-stress environment is also beneficial.

Home Care of a Rabbit with Enterotoxemia

A diet high in fiber and low in starch and sugars will be critical in returning the rabbit to health. The caregiver can best protect the bunny by feeding that same diet for the rabbit’s lifetime. As noted early in this article, grass hay plays a pivotal role in moving food through a rabbit’s digestive system, and so an unlimited amount of fresh grass-hay is recommended on a daily basis.

Caregivers can also help reduce a rabbit’s stress by discerning what causes anxiety or fear. Helping a bunny to feel safe and protected includes building trust, proper handling, good location of the rabbit’s house, safe play and exercise time, and proper introductions to other people and animals (including other rabbits). If the situation involves kits, removing baby rabbits from the mother is stressful for them all.

Caregivers can become knowledgeable about drugs considered safe for rabbits by perusing articles on this website, including where to find additional medical information.

ADDITIONAL CONSIDERATIONS

As already noted, diet plays a critical role in the proper functioning of the cecum, and veterinary guidelines can help return a rabbit to health. There are additional articles and FAQ sheets on this website that pertain to diet and other aspects of rabbit health. Working with your veterinarian to individualize your bunny’s diet – based on age, weight, health, and activity level – will help ensure his or her wellbeing.

Caregivers may want to consider supplementing their rabbit’s care with alternative therapies, some of which are addressed in separate articles posted on this website. There are times when combining the expertise of both standard and alternative treatments offers the best supportive care.

When researching complementary treatments, be aware of training and qualification requirements and give careful consideration to the health, nature, and needs of your rabbit. Be clear and realistic about your expectations and goals for treatment, which should prioritize your rabbit’s comfort and quality of life.

CHART: SIGNS OF DISORDERS OF THE CECUM

The chart below, based on information presented in this article, is for reference purposes only. Cecal motility disorders and enterotoxemia require the attention of a veterinarian to ensure proper diagnosis and treatment.

The differences in rabbit behavior (both when healthy and when ill) as well as the varying ways in which rabbits present signs of illness or injury emphasize the importance of familiarity with your own bunnies. It is beyond the scope of this article to address all cecal disorders.

Lumps in cecum may be felt with gentle palpation (caution: cecum easily bruised/ruptured; rabbit-savvy veterinarian should make this determination)

Enlarged, distended (can be very large) due to gas from GI shutdown. “Doughy” contents in cecum felt with gentle palpation (caution: cecum easily bruised/ruptured; rabbit-savvy veterinarian should make this determination)

Distended abdomen (cecum full of fluid and gas)

Additional Signs

Inflammation around anal area due to accumulation of cecotropes

In early stages behavior may be deceivingly normal

Silent gut or excessive gut sounds

“Water sloshing” sounds from liquid-filled cecum; soiled hindquarters

COW PILE SYNDROME

Cow pile syndrome, named for its most visible characteristic, may result from a combination of factors, including genetic, environmental, and dietary. Though not a medically recognized condition, brief mention is included because of some of the similarities with cecal motility disorders.

Determining whether a rabbit is suffering from a condition that affects the cecum or colon requires the skill of an experienced rabbit veterinarian. The caregiver can assist in the process by providing astute and accurate observations about the problem. Additional factors aid in the diagnostic process, including the history of medications, description of the diet (including dates and details of change), any possible foreign materials ingested and date of occurrence(s), and stress factors. Regardless of the condition, appropriate diet plays a crucial role in the recovery and health of the rabbit.

I wish to extend my sincere gratitude to Drs. Susan Brown, Tomáš Chlebeček, Bill Guerrera, Angela Lennox, and Scott Stahl for sharing their expertise in this article and additionally to Dr. Brown for her overall review of the article. Warm thanks also to Cheryl Abbott, Sandi Ackerman, Heidi Anderson, Dr. Stephanie Crispin, Gary McConville, and Karen Witzke for their suggestions. – Marie Mead

Marie Mead has been involved in various capacities with animal rescue, advocacy, and education for over twenty years. She has made a home with special-needs rabbits and other animals, all of them rescues. Author (with collaborator Nancy LaRoche) of Rabbits: Gentle Hearts, Valiant Spirits – Inspirational Stories of Rescue, Triumph, and Joy, Marie has also written rabbit-related stories and articles for other publications. Additional writings have covered topics such as aging and the environment.

Susan Brown, DVM is the founder and former owner of Midwest Bird and Exotic Animal Hospital (originally in Westchester, Illinois) and the current owner of Rosehaven Exotic Animal Veterinary Services and The Behavior Connection (North Aurora, Illinois). She is coauthor of Self-Assessment Color Review of Small Mammals and author of numerous lay and professional writings on rabbit medicine and care; she has also lectured extensively in the United States and Europe. She is involved in exotic animal care at rescue organizations and shelters. Utilizing the principles of behavior and training, she is teaching ways for people to live in harmony with their companion animals.

Tomáš Chlebeček, DVM is a former aerospace engineer who became a veterinarian as a result of his association with the Colorado House Rabbit Society. He received his degree from Colorado State University in 1999 and practiced at the Makai Animal Clinic in Kailua, Hawaii, before moving to the Czech Republic.

Bill Guerrera, DVM has always been interested in avian/exotic animal care and received his degree from Colorado State University. He has worked at the Denver Zoo, has presented various veterinary topics to local groups, and is a published author of several animal field studies. He is a partner at the Broomfield Veterinary Hospital in Broomfield, Colorado, where sixty percent of his patients are rabbits, including many from the Colorado House Rabbit Society. Dr. Guerrera also manages an online subscription-based website for people with veterinary-related rabbit questions: bunnyhopline.com.

Angela Lennox, DVM, Dipl ABVP (Avian) is a 1989 graduate of Purdue University, has practiced exotic animal medicine exclusively since 1991, and is the owner of Avian & Exotic Animal Clinic of Indianapolis (Indiana). As adjunct professor at Purdue University, she teaches both veterinary and veterinary technician students. Dr. Lennox is the author of numerous professional articles, coauthor of Clinical Radiology of Exotic Companion Animals, and editor of the Rabbit and Rodent Dentistry Handbook. She is past president of the Association of Exotic Mammal Veterinarians and has lectured extensively both nationally and internationally. She currently lives near Indianapolis with her husband of more than 20 years and four daughters.

Scott J. Stahl, DVM, DABVP-Avian graduated from the Virginia-Maryland Regional College of Veterinary Medicine in 1989 and is currently an adjunct professor in avian and exotic animal medicine there. He is the owner and director of Stahl Exotic Animal Veterinary Services (SEAVS) in Fairfax, Virginia (near Washington, DC). He has authored numerous book chapters and articles on avian and exotic animal medicine and surgery.

BIBLIOGRAPHY

My sincere thanks to the veterinarians named in this article for sharing their expertise during personal interviews and in subsequent feedback. In addition to House Rabbit Handbook: How to Live with an Urban Rabbit, the following list of publications, although by no means comprehensive, may assist those who desire additional research.

]]>Dental Disorders in Rabbitshttps://rabbit.org/dental-disorders-in-rabbits/
Mon, 21 Jan 2013 18:42:52 +0000http://rabbit.org/?p=12552Dental problems in rabbits can be complex and result in serious conditions. This article addresses the most common issues, including signs of dental disorders; pain management (analgesia); diagnosis, treatment, and home care of dental problems, including malocclusion of incisors and of molars; euthanasia; and prevention of dental disorders.

INTRODUCTION

Rabbits’ teeth are part of a complex digestive system that promotes efficient assimilation of plant materials that are indigestible to many other species. The front teeth include four sharp, chisel-like incisors: two on the top and two on the bottom. Behind the upper front teeth are two smaller peg incisors. When a rabbit is at rest, the bottom incisors nestle on the peg incisors, behind the lower edge of the upper front teeth.

There are twenty-two premolars and molars, often called cheek teeth when referred to as a group. Their deep grooves create ridges that are perfect for breaking down fibrous plant materials. In a healthy rabbit, the cheek teeth come into contact only during the chewing process.

Dr. Angela M. Lennox, who teaches rabbit dentistry and surgery at Purdue University and at veterinary conferences throughout the US and is the editor of Rabbit and Rodent Dentistry Handbook, explains the function and growth of the teeth:

Rabbits use their incisors to slice food, and the tongue moves the food into the mouth. The molars, moving in a lateral arc, grind the food on one side of the jaw at a time.

One of the most important features of the teeth is that they grow continuously throughout the rabbit’s lifetime. Teeth in healthy rabbits are properly worn down by the ingestion of rough plant materials.

It’s important for a rabbit’s teeth to retain their proper length, shape, and alignment. When tooth wear is decreased or abnormal, the risk of dental problems increases.

In Rabbit and Rodent Dentistry Handbook, Dr. Vittorio Capello indicates that the most common causes of dental disease are:

Congenital (hereditary)

Traumatic injury

Change in jaw formation

Primary malocclusion of the cheek teeth

Metabolic bone disease

All but genetic disorders are commonly referred to as acquired dental disease. Some researchers are focusing on the role of calcium metabolism in the development of dental disease. Dr. Lennox advises that at the present time there is much that remains unknown about calcium metabolism in rabbits; thus, this article does not address metabolic bone disease.

Dental problems can be very serious and may result in health issues from which it is difficult for a rabbit to recover. For example, overgrowth of molars can lead to obstruction of nasal passages, or the elongated apexes may cause blockage in the nasolacrimal duct. Reference the section below on prevention of dental disorders for information on ways to help your rabbit maintain healthy teeth.

Note: Rabbit teeth do not have true anatomical “roots.” That portion of the tooth is therefore referred to as an “apex,” the term used in this article.

SIGNS OF DENTAL DISORDERS

Though dental problems are common, our little prey companions often mask the condition so as not to appear vulnerable. Thus, it’s incumbent upon caregivers to note changes to behavior and appearance, including:

Pickiness about food or sudden change in food preferences

Dropping food

Drooling

Wet fur or matting on face and forelimbs

Eating or drinking less, with corresponding change in fecal output

Change in weight

Bad breath

Reduced activity

Reduced grooming behavior

Poor coat condition and loss of fur

Accumulation of cecotropes around the anus

Greater evidence of a problem includes:

Ocular (eye) discharge

Pain (e.g., hunched posture, grinding the teeth)

Lethargy

Refusal to drink

Anorexia/weight loss

Swelling on the face

It’s important to note that the clinical signs listed for dental disease are non-specific – they may be indicative of some other health problem. In addition, signs can sometimes be attributable to something other than a medical condition. For example, pickiness about food may be related to its quality or to a change in diet. Reduced activity may be a response to unfamiliar visitors. Anything that stresses a rabbit can alter behavior. Observing the variables that affect your rabbit makes it easier to detect problems before they become serious.

PAIN MANAGEMENT (ANALGESIA)

As previously noted, dental disorders often cause discomfort and pain, which in turn can cause severe stress in rabbits. In addition, dental procedures require the use of pain medication.

Dr. Teresa Bradley Bays, author and lecturer on exotic animal species, including rabbits, offers advice on the use of analgesics:

Analgesics should be provided immediately if pain is detected or if the rabbit patient is experiencing any illness or trauma that would be painful in other species, including humans. Pain medication should be administered by the veterinarian before proceeding with diagnostics and any other treatments.

Pain medicine should also be provided before surgery (to prevent wind-up pain), during surgery, and after surgery, as well as for recovery at home. A multimodal approach – where a combination of analgesic types are used – creates a synergistic effect that decreases the dose of each individual medication while providing better pain control.

COMMON DENTAL PROBLEMS: DIAGNOSIS AND TREATMENT

Introduction

Rabbit dentistry is complex, primarily because the teeth grow continuously. In addition, the mouth cavity is small, with cheek folds. Dental disorders can generally be successfully treated when the problem is identified in the early stage. Dr. Lennox offers this:

Proper diagnosis is enhanced with specialized dental examination tools (mouth gags and speculums), radiographs of the skull to see the position of the teeth, and in some cases with an endoscopic examination of the mouth. Sedation is required for thorough examination of the cheek teeth.

It’s important to obtain veterinarian care for all dental disorders. If a condition is left untended, serious problems result and the rabbit suffers a painful condition, which eventually becomes life-threatening.

Abscesses

Facial abscesses are most commonly associated with dental disease. Because they are serious and often difficult to treat, it’s important to consult with an experienced veterinarian.

Fractures

Fractures are serious injuries that can lead to other problems, including damage to apexes (and resulting abnormal tooth growth) as well as abscesses. Incisors may fracture during a fall or when a rabbit sustains some other head injury. When teeth are overgrown, they are more prone to fracture.

In addition, a tooth may fracture during improper dental treatment. Dr. Lennoxadds:

To examine and treat disorders in rabbits, it’s recommended that specialized dental equipment be used, including high-speed dental burrs to shorten and shape the teeth. Simply clipping overgrown teeth with nail clippers or rongeurs carries risk of tooth fracture and abscess, does not allow teeth to be restored to normal shape, and does not address underlying issues such as infection or disease of the molars.

It should be remembered that most disease of the incisors is secondary to disease of the molars.

Malocclusions

Malocclusion (misalignment) of the incisors is a noticeable problem. Sometimes the veterinarian may suggest that a rabbit’s front teeth be extracted. Dr. Lennox explains:

For rabbits with congenital jaw malformation and malalignment of the incisors without disease of the molars, frequent trimming of incisors often becomes necessary. For these rabbits, the best option may be extraction of the incisors. Rabbits do not require incisors to eat hay and pellets and usually do very well after extraction. Incisor extraction is a routine procedure for an experienced rabbit veterinarian [see below].

Molar malocclusion generally isn’t noticed until a rabbit begins to exhibit signs of distress or the rabbit is brought in for incisor treatment. Keep in mind that incisor overgrowth affects proper working of the jaw, thus impacting the health of the cheek teeth (and vice versa). If your rabbit has incisor problems, it is important to have cheek teeth checked regularly because it is unlikely that changes to molar alignment, shape, and growth will be visible in the early stages.

More detailed information about malocclusion of both incisors and cheek teeth is included below.

Spurs and Spikes

When cheek teeth are not wearing evenly, they form spurs or spikes that can lacerate the rabbit’s tongue, cheeks, and other soft mouth tissue. Though it may seem that a tiny, sharp point on a tooth would not cause serious problems, the opposite is true. As a rabbit tries to avoid use of a particular tooth, abnormal pressure is put on other teeth and the uneven wear becomes even greater. In addition, an abscess may form in the soft tissue.

Remember that a rabbit’s teeth are continuously growing. Therefore, the abnormal pressure of misaligned teeth on the other teeth is cause for discomfort. Additionally, the avoidance of one or more teeth can change the way a rabbit’s jaw normally rotates when eating food. Thus, what may seem like a small problem has the potential of negatively affecting the entire mouth (e.g., other teeth, muscles, ligaments).

Reference the information about fractures (above) for treatment of spurs and spikes.

MALOCCLUSION OF INCISORS: DIAGNOSIS, TREATMENT, PROGNOSIS, AND HOME CARE

Overview

Rabbits use their incisors to grip and slice their food as well as groom their bodies. When incisors are maloccluded (misaligned), repeated trips to the veterinarian for trimming and reshaping (including the anesthesia) can be stressful for the rabbit. Therefore, the decision to remove the incisors depends in part on the condition of the teeth and on how often they need to be trimmed.

If incisor malocclusion is congenital (hereditary), it can be assumed that the teeth will need trimming every four to six weeks throughout the bunny’s life and, as previously stated, extraction may be the best option. Other reasons for incisor extraction include fracture, endodontic disease, and facial abscess. (Rabbits do well without incisors; see the Home Care information below.)

This major surgery should be discussed in detail with a veterinarian experienced in rabbit dentistry. It’s important that the entire tooth (including pulp tissue) be removed, but even with the most skilled surgeon there is a slight chance that teeth will grow back.

Tooth extractions in rabbits are major surgery, so the health of the rabbit is a serious consideration. If there is an infection, the veterinarian will probably prescribe a round of antibiotics before extracting the teeth. Caregivers should also be aware that obese or older rabbits are a higher surgical risk.

When a rabbit is not healthy enough to undergo surgery, the preferred method of maintaining incisors is with a high-speed, water-cooled burr, with a guard to prevent mouth injury. It may be necessary to sedate the rabbit to protect from movement injuries to the mouth and tongue.

Diagnostic Procedures

Because incisor misalignment is often accompanied by cheek teeth malocclusion, a full dental exam is often performed using anesthesia, a rabbit mouth speculum, cheek spreaders, and radiographs (X-rays).

Post-Surgical Procedures

Following surgery, the veterinarian should assure that the extracted teeth were removed in entirety. This is done both by examination of the teeth and by comparing pre- and post-surgical skull radiographs. If any apex or pulp tissue remains, there may be steps that can be taken to prevent the teeth from growing back or developing an abscess.

The wound should be flushed, antibiotics will reduce the risk of infection, and post-surgical analgesics will help manage the pain. Additionally, fluids may be administered and the rabbit syringe-fed.

Home Care of a Rabbit with Incisor Extraction

Aftercare for incisor extraction will vary, based on the severity of the disorder and the dental procedures. Discomfort may cause stress and a resulting gastrointestinal disorder. The veterinarian may prescribe a home-care regimen that includes administration of the following:

Within hours of surgical recovery, the bunny can be expected to start eating on his or her own. However, it’s important to remain alert to signs of GI hypomotility/stasis and take immediate and appropriate action.

Rabbits without their incisors use their lips and tongue to pick up food and move it to the back of their mouth, where it’s ground by the molars. To help prevent additional dental problems, veterinarians recommend a diet high in fiber (grass hay). To compensate for the lack of incisors, caregivers can help their bunnies to eat by tearing leafy green vegetables into rabbit-sized bites.

Since a rabbit uses the front teeth to pull dead hair from the body, the bunny will need grooming assistance from the human caregiver.

MALOCCLUSION OF MOLARS: DIAGNOSIS, TREATMENT, PROGNOSIS, AND HOME CARE

Overview

According to Dr. Angela Lennox, there are two leading theories for the cause of acquired dental disease of the molars: inappropriate wear from improper diet and metabolic bone disease.

When any irregular growth occurs, all cheek teeth are affected. Abnormal wear and growth necessarily result, affecting the entire mouth, including the musculature. The normal workings of a rabbit’s jaw require all the teeth to be properly formed and in alignment.

Severe dental disease from any cause can lead to the most severe complication: dental abscesses and resulting bone infection (osteomyelitis).

Diagnostic Procedures

Some of the steps that a veterinarian may take to assess the molars include:

Administering anesthesia to allow for complete examination and to reduce stress in the rabbit (if the rabbit’s overall health permits)

Gently feeling along the jaw for signs of swelling or tenderness

Removing any food from the teeth and checking for infection

Using a small speculum to see inside the small, narrow mouth cavity

Taking radiographs of the entire skull (several views) to see the extent of apex elongation and any abscess formation

Comparing the radiographs with those of a rabbit without dental problems will help determine the severity of the condition; however, there are some considerations with this. Dr. Bradley Bays notes that multiple views are necessary and that some caution is warranted in radiograph interpretation. She explains:

Standard skull radiographs may show some malocclusion of cheek teeth, but it’s difficult to discern the full extent of malocclusion due to superimposition of the right and left arcades. This can be overcome by taking a number of special radiographic views, in particular, oblique views where the skull is slightly rotated.

Surgical Procedures and Related Treatment

Unless a molar is loose or there is an infection, molar extraction is not recommended due to the arrangement and function of a rabbit’s teeth. If surgery is not necessary, Dr. Lennox advises:

When problems involve the cheek teeth, use of specialized dental equipment for rabbits is recommended to bring the teeth back to normal shape and size. Success of the correction is judged visually and by post-procedure radiographs. Simply reducing teeth down to the gum level may not be appropriate.

When major surgery to extract the molars proves necessary, it’s best if the rabbit is in basically good health and at a desired weight. Discuss with the veterinarian the long-term prognosis. The after-care can be extensive, additional surgeries may be required, and periodic dental exams, often under anesthesia, will certainly be necessary.

If there is an abscess, extracting the entire pus pocket (as a solid mass) is key to containment of the bacteria. The surgery can result in extensive bone loss because the affected bone and surrounding tissue have to be removed to prevent bacteria spread; this surgical cutting away is often referred to as debriding or excising. In addition, there may be more than one abscess.

A culture and sensitivity test will help determine the cause of the infection as well as the correct antibiotic. It is likely that the rabbit will require both systemic and local medication. There are several recognized methods of administering antibiotics locally, including powder and beads; manuka honey has been used with success in some difficult cases. In addition, whether to close the wound or leave it open for possible additional treatment as well as flushing are serious considerations.

Post-Surgical Procedures and Prognosis for Recovery

Depending on the level of the caregiver’s expertise, the rabbit may have to remain in the hospital to ensure proper care. Whether at home or hospitalized, watching for signs of digestive problems is very important. Following extraction, treatment will likely include:

Subcutaneous fluids

Syringe-feeding (after the rabbit has stabilized)

Analgesic (pain medication)

Antibiotic

Wound care, including flushing and filling

Medication to support the gastrointestinal system, if needed

Though there is an extremely high rate of abscess recurrence (not necessarily in the same area), the prognosis for recovery will be better if the pus is extracted in entirety, with both the contaminated bone and surrounding tissue surgically excised. Appropriate after-care must also be administered.

The prognosis is poor if a total extraction and bone removal are not possible. In such case, the rabbit will be more comfortable with the abscess removed, but the difficult decision regarding euthanasia will arise if the abscess returns.

Home Care of a Rabbit with Molar Extraction

Molar extraction is a very painful surgery and the rabbit will require an intensive home-care regimen outlined by the surgeon, most likely including:

Analgesic (pain medication)

Antibiotic

Wound flushing

Syringe-feeding

Treatment for GI hypomotility, if necessary

Because the antibiotics will probably be administered for at least a month, digestive upset is possible, given that the normal balance of flora in the gut may be affected. Some veterinarians may prescribe probiotics for rabbits on antibiotics for extended periods of time; the efficacy of presently available probiotics is currently unknown.

Once the rabbit is eating normally, a high-fiber diet helps maintain health. Though the elimination of unhealthy treats can be done immediately, a change in the type and amount of food should be accomplished slowly – especially if the rabbit is not eating the proper quantities of grass hay and leafy greens – to prevent life-threatening hepatic lipidosis (reference “Liver (Hepatic) Disease in Rabbits”).

Following molar extraction, it’s critical that caregivers adhere to the surgeon’s instructions. Without the necessary commitment to that care, including regular dental rechecks, the rabbit’s chances for recovery are poor.

EUTHANASIA

Euthanasia is not needed for dental disorders that are caught in the early stages. However, when it’s obvious that the rabbit’s quality of life is becoming compromised and treatment is not likely to help, euthanasia may be the most loving option.

PREVENTION OF DENTAL DISORDERS

Diet

Unfortunately, it’s unclear what causes acquired dental disease in all rabbits, but diet is considered an important factor. The way in which foods can affect dental wear has already been noted in this article. Basically, when a diet lacks sufficient fiber, the teeth grow faster than they are worn down, resulting in uneven and unusual length, misalignment (malocclusion), food impaction, abnormal curvature, sharp points (spurs/spikes), loose molars, apexes that invade surrounding tissue, and other problems.

Because caregivers are in control of the diet, this aspect of rabbit care is emphasized. Dr. Lennox shares this:

Studies on wild European rabbits (from which our domestic rabbits descended) show the diet is composed of very coarse fibrous plant materials that are high in silicates, which promote the normal wearing of teeth. The closest we have to that is grass hay. Some hay may be vitamin and mineral deficient (depending on soil conditions, harvesting, storage, and packaging), which emphasizes the need for feeding a variety of quality grass hays.

Research emphasizes the need for hay in a rabbit’s diet, not only for healthy teeth but also for proper function of the digestive system. However, due to variances in hay quality, it’s usually recommended that processed pellets be fed in limited amounts, based on the weight and overall condition of the rabbit. The pellets should be grass-hay-based and of high quality (e.g., not containing soy, dried beans, grains, seeds, or pieces of fruit).

Caregivers should remember that pellets are higher in caloric density, meaning that rabbits who eat pellets are quickly satiated. When allowed to free-feed or to eat too many pellets, rabbits don’t browse hay in the amounts needed. It may be useful for caregivers to remember that pellets were developed for rabbits in production (breeding industry) or going to slaughter (meat industry) to minimize mess and to optimize fast growth and pelt development. This obviously is not the goal for our companion rabbits.

Leafy vegetable greens are important to a rabbit’s diet because they are vitamin-rich; however, greens should be fed in measured amounts so that the rabbit does not forgo eating hay.

Regarding processed pellets as part of the diet, Dr. Bradley Bays advises further:

Processed food pellets are too small and soft to wear teeth down properly. In addition to needing less chewing time, pellets cause the rabbit to chew in an up-and-down motion rather than the natural side-to-side motion that keeps the teeth ground down. Research shows that poor diet – which includes overfeeding of pellets – can lead to improper molar wear, which, in turn, increases the incidence of acquired dental disease.

If it is unsafe for your rabbit to browse the yard, pick and offer some grass shoots, clover, or other chemical-free, rabbit-safe plants. Plants found in the natural environment, including those that look succulent, are generally more fibrous than purchased greens.

Reference the various articles and FAQ sheets on this website for additional information about diet, including recommended vegetables as well as treats. Each rabbit is unique, and some breeds seem more prone to dental problems than others. Individualizing your bunny’s diet, based on age, weight, health, and activity level will help ensure his or her well-being.

Traumatic Injury and Changes in Jaw Formation

Traumatic injury and changes in jaw formation are two additional causes of dental disease. To the extent possible, human guardians ensure their rabbits’ safety against such trauma. But seemingly small “injuries” can occur, and they have the potential for changing jaw formation and negatively affecting teeth alignment. For example, a caged rabbit who pulls or chews on the metal enclosure can suffer damage because the action can change teeth alignment, and even a slight change can have significant impact. Providing more play and runaround time may reduce the rabbit’s frustration at being caged and stop the behavior.

Though caregivers may not want to cage their rabbits, there are times when it may be unsafe for them to roam the house. Alternatives to caging include playpens, perhaps joined together to create a larger space, or a baby gate to restrict the bunnies to a particular area of the home.

CONCLUSION

Rabbits are marvelously constructed to get the most nutrient value from low-energy foods. In addition to providing regular medical care, help keep your bunny’s teeth healthy by giving him or her safe things to chew on. These might include untreated willow baskets, cardboard boxes, and unsprayed apple branches. Provide unlimited grass hay, which not only helps wear the teeth evenly but also acts as an important digestive aid. (Reference “Disorders of the Cecum of the Rabbit” for more information about the important function that hay serves.)

Caregivers may want to consider supplementing their rabbit’s care with alternative therapies, some of which are addressed in separate articles posted on this website. There are times when combining the expertise of both standard and alternative treatments offers the best supportive care.

When researching complementary treatments, be aware of training and qualification requirements and give careful consideration to the health, nature, and needs of your rabbit. Be clear and realistic about your expectations and goals for treatment, which should prioritize your rabbit’s comfort and quality of life.

I wish to extend my sincere gratitude to Dr. Teresa Bradley Bays and Dr. Angela Lennox for sharing their expertise in this article and to Dr. Susan Brown for her review of it. Warm thanks also to Cheryl Abbott, Sandi Ackerman, Heidi Anderson, Dr. Stephanie Crispin, Nancy and Gary McConville, and Karen Witzke for their suggestions. – Marie Mead

Marie Mead has been involved in various capacities with animal rescue, advocacy, and education for over twenty years. She has made a home with special-needs rabbits and other animals, all of them rescues. Author (with collaborator Nancy LaRoche) of Rabbits: Gentle Hearts, Valiant Spirits – Inspirational Stories of Rescue, Triumph, and Joy, Marie has also written rabbit-related stories and articles for other publications. Additional writings have covered topics such as aging and the environment.

Teresa Bradley Bays, DVM, CVA, DABVP (Exotic Companion Mammal Specialist) practices in Missouri at the Belton Animal Clinic and Exotic Care Center. She is the author of numerous articles and book chapters on exotic animals and is the senior editor and coauthor of Exotic Pet Behavior: Birds, Reptiles, and Small Mammals. Dr. Bradley Bays speaks nationally and internationally on exotic animal medicine and surgery. She is also actively involved with community service as veterinarian for HELP Humane, veterinarian for an animal facility at a domestic violence shelter, and founder and coordinator of the Pajamas for Foster Kids Program (www.beltonanimal.com for additional information).

Angela Lennox, DVM, Dipl ABVP (Avian) is a 1989 graduate of Purdue University and has practiced exotic animal medicine exclusively since 1991; she is the owner of Avian & Exotic Animal Clinic of Indianapolis (Indiana). As adjunct professor at Purdue University, she teaches both veterinary and veterinary technician students. Dr. Lennox is the author of numerous professional articles, coauthor of Clinical Radiology of Exotic Companion Animals, and editor of Rabbit and Rodent Dentistry Handbook. She is past president of the Association of Exotic Mammal Veterinarians and has lectured extensively both nationally and internationally. She currently lives near Indianapolis with her husband of more than 20 years and four daughters. www.exoticvetclinic.com

BIBLIOGRAPHY

My sincere thanks to the veterinarians named in this article for sharing their expertise during personal interviews and in subsequent feedback. In addition to House Rabbit Handbook: How to Live with an Urban Rabbit, the following list of publications, although by no means comprehensive, may assist those who desire additional research.

]]>Advances in Rabbit Care in the Past 20 Yearshttps://rabbit.org/advances-in-rabbit-care-in-the-past-twenty-years/
Sun, 10 Jun 2012 20:41:50 +0000http://rabbit.org/wordpress/?p=6717There have been many exciting advances in rabbit medicine and surgery in the past twenty years. Some of these advances have revolutionized treatment of common problems like gastrointestinal stasis, dental disease, abscesses, and nutritional imbalances. Twenty years ago veterinary care specifically oriented to rabbits was rare. Now veterinarians and organizations have improved rabbit medicine so significantly that rabbits are the third most common mammal to seek veterinary services.

In 1988, House Rabbit Society was founded. This one group has been a primary, fundamental supporter for many of the advances in rabbit medicine. Through their membership and educational support they are the most influential group changing the lives of rabbits today. They are responsible in for getting rabbits out of the backyard and into the house and becoming an integral part of the family.

The first significant new medication that came out in 1989 was Baytril.® This was the first fluoroquinolone antibiotic to enter the veterinary market. The fluoroquinolones are also the first major new class of antibiotics since the sulfonamides in the 1940’s. Because of the normal bacteria in a rabbit’s digestive tract, many antibiotics used in other species are not safe for use in rabbits.

Enrofloxacin (Baytril, Bayer HealthCare, introduced in 1989), orbifloxacin (Orbax, Schering-Plough, introduced in 1997) and marbofloxacin (Zeniuin/Zeniquin, Pfizer Animal Health, introduced in 1999) have two major advantages: high bioavailability and activity against Pseudomonas (and many other gram negative and gram positive bacteria). The fluoroquinolones are broad spectrum and bacteriocidal. This class of drugs is the first that is effective in an oral form to fight Pseudomonas. It is also extremely effective against other common causes of infections in rabbits like Pasteurella multocida, Mycoplasma sp., Staphlococcus sp., E. coli, Salmonella, and many others. A caveat is that some bacteria are developing resistance to Baytril because of its overuse. This can happen when any antibiotic is used inappropriately or indiscriminately.

The next medication is a new sulfa antibiotic sulfadimethoxine/ormetoprim (Primor,® Pfizer Animal Health), it is very similar to sulfamethoxazole/trimethoprim (Bactrim,® Roche) except the trimethopim was replaced with ormethorpim. This drug was introduced in 1993 and is broad spectrum, bactericidal and anti-protozoal (will treat for coccidia).

Another new anti-protozoal drug called ponazeril (Marquis,® Bayer HealthCare) was introduced in 2001. This drug kills coccidia by targeting the plastid body in the protozoan and only requires two days of treatment. This drug is coccidiacidal not coccidiastatic like sulfadimethoxine (Albon,® Pfizer Animal Health) and other sulfa drugs. This drug has also recently been used for Encephalitazoon cuniculi with promising results.

There are several other drugs now available that weren’t available twenty years ago that increase gastrointestinal motility, reduce pain and inflammation, and provide long term local concentrations of antibiotics.

A new small promotility medication called cisapride (Propulsid,® Janssen Pharmaceutica) was introduced in 1992 and the mechanism of action is to normalize concentrations contractions in the stomach, acts in multiple points throughout the gastrointestinal tract and doesn’t cross the blood brain barrier (like metoclopramide does). So this drug only works locally, not centrally and cannot cause any changes in mentation.2

The strongly anticipated non-steroidal anti-inflammatory drug (NSAID) called meloxicam (Metacam,® Boehringer-Ingelheim) was introduced in the United States in 2003. In rabbits some NSAIDs can have severe side effects. Metacam is a preferential COX-2 inhibitor and has 50-100% fewer potential side effects when used conservatively.

There are also medications that can be placed surgically. Antibiotic impregnated polymethylmethacrylate beads (AIPMMA Beads) and pluronic gel (Poloxomer 407) are two ways of placing a particular antibiotic at a local site in an abscess that will give a locally acting long-term antibiotic exposure. This has increased the success rates for treatment of jaw abscesses, dental disease, and abscesses throughout the body.

Rabbit dentistry has improved the most in the last ten years. Dental disease is responsible for many of the sick, anorexic rabbits that are seen in veterinary clinics today. We now have appropriate instruments to treat these problems. Since 1996, many dental instruments specific for rabbits have been commercially reduced. Cheek dilators and rabbit mouth gags allow better visualization & protect the tissue in the mouth. In 1997 the molar extraction forceps and molar cutters were made available. These instruments made it more successful to at remove large spurs and fractured or infected cheek teeth.

In 1998 the Crossley rabbit incisor luxator, and in 2000 the Crossley molar luxator were introduced into the veterinary market. These two instruments revolutionized dental extractions, making veterinary dentistry more successful and less traumatic. As our patients are living longer this certainly improves their quality of life.

Rabbit nutritional advances have been tremendous in the last fifteen years. Diet recommendations used to be that pellets make up 80% of the rabbits diet with the other 20% being hay and veggies. Today, the recommendations are that hay and veggies be 80-90 percent of the rabbit’s diet with pellets ideally as low as possible, from 10 to 20 percent. There are now numerous feed companies that sell excellent quality grass hays, nutritionally excellent rabbit food pellets and formulas specifically for syringe feeding sick rabbits.

We still have to travel a long way to understand and cure some of the problems facing our house rabbits, but the last twenty years have produced so many advances and fundamental changes in general husbandry, medicine, surgery and supportive care, as well as the development of new drugs and instruments that rabbit medicine has become a very competent and progressive field in veterinary medicine.

Notes

1. Coccidia are tiny internal parasites (Eimeria spp) that live in the cells of the rabbit’s intestines. The tiny oocysts containing the infective stages are passed in the feces and are picked up by other rabbits through contaminated feed and water.
2. The process of reasoning and thinking
3. Lack of appetite

Advances in Information and Knowledge Sharing

Twenty years ago, most veterinary schools limited instruction in rabbit medicine to an elective course covering laboratory species, including rabbits, rats, mice and primates. Today it is rare that a university veterinary program does not have a department for exotic animal medicine in some form, providing much more extensive training in rabbit medicine. However, you will still want your rabbit cared for by a doctor with a specialization in exotic animal medicine. In addition to other sources for locating one, you might contact your local or state veterinary medical association who may have referrals for veterinarians with special interest in exotic species. In April 2008, the American Veterinary Medical Association (AVMA) granted provisional recognition to the first completely new veterinary specialty since 1993, called Exotic Companion Mammal Practice (ECM). This will hopefully set even higher standards for exotic mammal care but there may be many highly qualified practitioners who cannot yet invest the resources necessary to become board certified.

There are now several organizations for veterinarians who share an interest in exotic mammal medicine:

The Association of Exotic Mammal Veterinarians (AEMV) was established in 2000. Paid members have access to an online AEMV Internet Forum, as well as to AEMV Journal articles published quarterly in The Journal of Exotic Pet Medicine. One of the largest sources for veterinarians to access on-line information about exotic mammals is the Veterinary Information Network. (vin.com) They have a forum just for rabbits which is run by veterinarians at both the academic and practice level who are experts in the field. Zoological Education Network website is home to Exotic D.V.M. magazine and other materials including veterinary texts and client education materials. They sponsor a free online discussion group called the ExoticD.V.M. On-Line Forum, designed to promote and facilitate discussion of exotic animal medicine among veterinarians who wish to provide quality care of non-traditional companion animals. Subscribers to this chat group must be either licensed veterinarians or veterinary students enrolled in an accredited institution.

House Rabbit Society hosted the first conference for veterinarians devoted entirely to rabbits in 1997. Although this has thus far been the only rabbit exclusive conference, many of the larger veterinary conferences including the AVMA annual conference now routinely include speakers on small exotic mammal medicine. Two of the largest whose exotic programs are always extensive are the North American Veterinary Conference and the Western States Veterinary Conference. 2009 marked the 16th year for the Annual Mid-Western Exotic Animal Medicine Conference.

Prior to 1989 there were very few medical textbooks focusing on rabbits: The Biology and Medicine of Rabbits and Rodents, By John E. Harkness and Joseph E.Wagner. 1st Edition, 1977, 5th Edition 2010. ISBN: 978-068303919.

]]>Pain in Rabbitshttps://rabbit.org/what-is-pain-2/
Thu, 07 Jun 2012 21:43:10 +0000http://rabbit.org/wordpress/?p=6548Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is not well understood, either in humans or other animals. Since it is complex and cannot be measured directly, pain is subjective. I’m sure you can think of two people who might undergo the same unpleasant experience, but each will have a different description of the pain. We assume that as each person interprets pain differently, each individual animal also experiences pain differently. Animals cannot communicate with us verbally, making it especially difficult to identify, classify and quantify their pain. Yet the anatomic and chemical pathways of pain and its perception are similar in all animals. Therefore we work with the premise that conditions that are painful to a human are also painful to animals, such as our rabbits.

ATTITUDES ABOUT PAIN ARE CHANGING
Because rabbits can’t talk to us, caregivers and veterinarians have traditionally relied on the observation of pain-induced behaviors to decide when it is time to intervene. We interpret pain as an indication that there is an underlying problem, and in the past, the approach was to correct the problem and assume that the pain would then resolve. The current thinking is that we want to be sensitive to the subtle signs of pain, because the treatment of pain itself can aid healing. It is not only rabbit owners and veterinarians who are changing their attitudes. Human infants are similar to rabbits in many ways, because they also communicate in ways that can be obscure and challenging for parents and doctors to understand. Professionals in both pediatric and veterinary medicine are learning that subtle changes in behavior may be the only indication that an animal or child is in discomfort. Pain is being actively studied in both human and veterinary medicine over the past 15 to 20 years.

Researchers in veterinary medicine are asking questions such as:

1) How can we recognize signs of pain in our patients?
2) What types of benefits are associated with adequate pain control?
3) How can we differentiate pain from anxiety?
4) What types of drugs are effective in alleviating pain?
5) How do different types of animals respond to different treatments?

HOW CAN WE RECOGNIZE PAIN IN RABBITS?
When working with rabbits, the practitioner must infer the presence of pain by observing changes from normal behavior. A normal rabbit is bright, alert, active, inquisitive, has a smooth coat and good body condition. Pain may be evident as a limp or a change in gait, withdrawal or protection of an injured part, awkward or abnormal postures, licking, rubbing or scratching at an area, or indicated by decreased food and water intake. It is important to know that rabbits evolved as a prey species, an animal that normally needs to hide any handicap in order to escape predation. Signs of pain may be subtle, such as an increase in respiration, reluctance to move, sudden aggression, persistently squinting the eyes, a loss of interest in the surroundings or an inability to rest or sleep normally. If there is abdominal pain, a rabbit may sit in a hunched posture. A rabbit with sore feet may lie stretched out, however a rabbit stretched out with feet kicked back can also be showing that he is content and relaxed. Loud tooth grinding can indicate pain, particularly if it is associated with the other signs listed above. However, rabbits can normally exhibit quieter, infrequent tooth grinding as a sign of contentment. It is unusual for rabbits to vocalize, but when they experience sudden pain or anxiety they may give a high-pitched squeal, quite unnerving to any person hearing it. Very often the presence of pain in rabbits is under-diagnosed by both caregivers and veterinarians, and when it is recognized it is often underestimated. It is very difficult to differentiate pain from anxiety in rabbits, especially since they are often combined and may be manifested by similar changes in behavior. Differentiating pain from anxiety may be simplified by a basic acceptance that rabbits will be anxious whenever they are placed in an unfamiliar environment.

IS IT USEFUL FOR AN ANIMAL TO FEEL PAIN?
Veterinarians were taught for many years that animals needed a certain level of pain when there was an injury, or post-surgically to prevent the pet from further injuring himself by moving around too much. However, we now know that excessive pain can be detrimental, and even life-threatening in animals, particularly the prey species. Current medical thinking has led practitioners to try to understand and minimize the detrimental effects of pain. Excessive pain can prolong recovery time from illness or injury. It can cause a rabbit to stop eating, with the consequence being a slowing and eventually shut down of the gastrointestinal tract and death. Rabbits in excessive pain also can go into shock and die within 24 to 48 hours despite the fact the illness or injury itself may not have been life-threatening.

WHAT BENEFITS ARE ASSOCIATED WITH PAIN CONTROL?
We still have a long way to go both in evaluating pain in rabbits and in effectively managing it for their benefit. Human medical researchers have tried to document the benefits of pain control. Most of the veterinary studies have looked at dogs and cats because these are the most common animals brought to veterinary practices. Some of the benefits of pain control include improved breathing functions, decreasing stress responses surrounding surgery, decreased length of hospitalization, faster recovery to normal mobility, improved rates of healing and even decreasing the spread of cancer after surgery. Almost all studies show people and animals return to normal eating and drinking habits sooner when given relief from pain. Therefore prevention, early recognition and aggressive management of pain and anxiety should be essential to the veterinary care of rabbits. Rabbit owners are justified in requesting support from their veterinarian on this issue. It is a good idea to assume that any invasive surgery can potentially be painful for a rabbit. Rabbits tend to return to eating and recover faster following spay and neutering surgeries when provided an analgesic to relieve pain during the surgery and for at least 24 hours following the surgery.

WHAT CAN WE DO TO REDUCE PAIN?
Pain is only one of many stress factors that sick rabbits must face. Sick rabbits need to cope with their disease or injury in addition to stressful changes that come with the problem. A sick rabbit usually has to leave his familiar surroundings and travel to the veterinary hospital, a strange environment with threatening noises and smells. He may also be separated from his human and/or rabbit friends. The veterinarian, usually a stranger to the rabbit, palpates, pokes and moves painful parts of the rabbit’s body. The doctor may need to restrain him and take blood or perform other diagnostic procedures. We need to try to see the environment from the rabbit’s perspective. We can reduce frightening and/or painful aspects of a procedure by petting the rabbit, speaking in soft tones, using good nursing practices and providing a home and hospital environment that is conducive to making the bunny feel safe and reducing anxiety. Rabbits respond better and may recover faster if returned to their familiar home environment as soon as possible. It is a strongly held belief by many rabbit owners that rabbits are comforted by being with a familiar companion rabbit whenever possible during a veterinary hospital stay. However, caregivers must also listen to the veterinarian’s decision because there are occasions that warrant keeping the rabbit alone for observation and sample collection.

WHAT IS ANALGESIA?
Analgesia literally means absence of pain sensation. The realistic use of analgesia is meant to relieve pain and discomfort through medication. There is not one drug that abolishes pain without complete anesthesia or loss of consciousness. Unfortunately, not all medications work exactly the same in every animal or human. This makes it difficult for the veterinarian to determine how effective or even how long a treatment may be effective in an individual. Treatment may involve many different levels of providing comfort.

WHAT TYPES OF MEDICATION CAN CONTROL PAIN?
When a rabbit needs to be hospitalized, the veterinarian may choose to give medication to reduce anxiety, such as midazolam. Rabbits require high dosages of this type of drug and may appear quite drowsy, yet when they are moved or examined, they become very alert. Your veterinarian will assess your rabbit and his disorder prior to prescribing any medication. There are no drugs developed specifically for rabbits, but many analgesics have been evaluated for rabbits, and dosages are available. There are several different categories of medication to control pain, and these will be briefly described:

Local anesthetics, such as lidocaine, provide excellent analgesia provided that the local block is given over the entire surgical area. Veterinarians use local anesthetics for minor surgical procedures such as skin biopsies, or they can be used in the immediate area of surgical incision as a supplement to general analgesia.

Non-steroidal anti-inflammatory drugs (NSAIDS), such as aspirin, carprofen, flunixin meglumine, and meloxicam are able to decrease swelling and inflammation. The potency of different NSAIDS varies with each drug, dose and type of pain. Rabbits require high dosages of aspirin, but it can be a very effective analgesic. It can be administered at home, but should be used only under veterinary supervision. Caution should be exercised if NSAIDS are used for very long time periods because they may produce negative side effects in the gastrointestinal tract and the kidneys. When rabbits require NSAIDs for chronic conditions such as arthritis, the veterinarian may want to re-examine and take blood from the rabbit to make sure these organs stay healthy.

Alpha-2-Agonists, such as xylazine, are powerful analgesics especially for the treatment of abdominal organ pain. But these drugs also produce deep sedation and depression of the heart rate and blood pressure. Therefore, this type of drug is not often used for relief of pain after surgery, although it can be used as part of the surgical anesthesia drug combination.

Narcotics include a diverse group of drugs in the opioid family. Opiods are the strongest and most effective analgesics for the treatment of pain but there are well-known side effects and disadvantages. Veterinarians often use narcotics for rabbits just prior to surgery, during surgery and immediately following surgery. Most opioid drugs are controlled by the Federal Drug Administration and can be difficult for veterinarians to prescribe for home use.

Your veterinarian should be able to recommend an appropriate plan to alleviate your rabbit’s pain once a diagnosis has been made. Do not try to develop your own home remedies for pain relief. Each medication has side effects that could be very dangerous for your rabbit. As a caregiver, you can do a number of things to minimize your rabbit’s discomfort such as careful handling of the sick rabbit, prompt communication with your veterinarian, gentle nursing care and rest to improve your rabbit’s comfort, access to food and water and a palatable diet to keep the rabbit eating. It is important to prevent changes in gastrointestinal motility especially when the rabbit is already stressed by disease.